OVERVIEW

What is Neonatal Abstinence Syndrome?

Neonatal Abstinence Syndrome (NAS), also translated as "Neonatal Abstinence Syndrome" or referred to as Neonatal Drug Withdrawal Syndrome, occurs when a mother uses addictive substances (such as morphine, heroin, fentanyl, ethanol, anti-anxiety/depressants, etc.) heavily or for an extended period during pregnancy, leading to dependence on these drugs. These substances cross the placenta, causing the fetus to develop a degree of dependence as well.

After birth, the newborn is no longer exposed to the high drug concentration from the mother, leading to a gradual decline in drug levels in the baby's blood. This triggers a series of abnormal symptoms, collectively termed Neonatal Abstinence Syndrome.

Similar to how a person reliant on sleeping pills becomes hyperactive when suddenly deprived of them, the baby loses the drug-induced suppression of the nervous system and exhibits excessive excitability. The earlier the drug use during pregnancy, the longer the duration, the higher the dosage, or the use of multiple addictive substances, the greater the harm to the baby.

What is the Recovery Like for Neonatal Abstinence Syndrome?

The onset time varies significantly but typically occurs within 24–48 hours after birth. Main symptoms involve neurological, respiratory, digestive, and autonomic nervous system dysfunction. Severity ranges from mild to moderate or severe. Mild cases may only require symptomatic treatment, while moderate to severe cases need tailored therapies.

Generally, mild cases may not require medication and can be managed with supportive care, such as reducing external stimuli, providing adequate calories, fluid therapy, and maintaining internal balance. Moderate to severe cases or those unresponsive to supportive treatment may need pharmacological intervention (e.g., morphine, methadone, clonidine).

NAS increases the risk of early neonatal complications (e.g., hypoglycemia, asphyxia, developmental abnormalities). Severe cases may result in early death from respiratory failure. Survivors face a 5–10 times higher risk of sudden infant death syndrome (SIDS) compared to healthy full-term infants and may experience long-term neurobehavioral and cognitive developmental delays.

SYMPTOMS

When do symptoms of neonatal abstinence syndrome generally appear after birth?

The onset time, clinical manifestations, and severity of neonatal abstinence syndrome vary greatly, mainly depending on the type, dosage, and duration of the mother's drug use, the time between the last drug use and delivery, gestational age and birth weight, whether anesthesia was used during delivery and its dosage, as well as whether the newborn has other diseases and the environment in which the newborn is placed.

Generally, the larger the mother's drug dose, the faster the drug metabolism, the greater the gestational age, the less fetal fat content, and the longer the time between the mother's last drug use and delivery, the earlier the onset of symptoms in the newborn.

What are the common manifestations of neonatal abstinence syndrome?

The clinical manifestations are nonspecific. Different addictive drugs can cause vastly different clinical manifestations of neonatal abstinence syndrome, but the common features are symptoms and signs related to the central nervous, digestive, respiratory, circulatory, and autonomic nervous systems:

• Central nervous system excitability symptoms: limb tremors, high-pitched crying, convulsions, difficulty sleeping, finger-sucking, prolonged eye-opening, etc. Excessive limb movement may lead to skin abrasions on the knees, elbows, and heels;
• Digestive system manifestations: poor feeding or constant hunger, repeated sucking or swallowing movements, vomiting, diarrhea, dehydration, and failure to gain weight;
• Respiratory system manifestations: rapid breathing but no difficulty breathing;
• Circulatory system manifestations: increased or decreased heart rate, elevated blood pressure;
• Autonomic nervous system manifestations: excessive sweating, nasal congestion, frequent yawning and sneezing, drooling, flushed skin, unstable body temperature, etc.

Episodes may gradually progress from mild to severe, or severe acute symptoms may gradually lessen, or symptoms may fluctuate in severity and persist for weeks to months.

How is the severity of neonatal abstinence syndrome determined?

Neonatal abstinence syndrome is classified into mild, moderate, and severe based on clinical manifestations. Mild cases show slight abnormalities, moderate cases exhibit symptoms upon stimulation, and severe cases have symptoms even at rest.

What serious consequences can neonatal abstinence syndrome cause?

Neonatal abstinence syndrome can significantly increase neonatal mortality and the risk of short- and long-term complications. Early on, sudden respiratory center depression may lead to death, increasing the risk of sudden infant death. Long-term effects may include neurobehavioral and cognitive developmental delays.

Will neonatal abstinence syndrome affect the baby's growth and development? Will it affect intelligence?

Studies have found that neonatal abstinence syndrome can lead to developmental delays and may cause attention deficits, visual impairments, hyperactivity, poor learning ability, and other behavioral problems, reducing the baby's problem-solving abilities and affecting IQ development. Different drugs have varying effects on the baby.

CAUSES

Causes of Neonatal Abstinence Syndrome?

The sole cause is the mother's long-term or excessive use of addictive substances such as sedatives, anesthetics, analgesics, or hallucinogens (e.g., morphine, heroin, fentanyl, ethanol, anti-anxiety or antidepressant drugs) during pregnancy.

Which Newborns Are More Likely to Develop Neonatal Abstinence Syndrome?

Babies born to mothers who used sedatives, anesthetics, analgesics, or hallucinogens excessively or long-term during pregnancy are at high risk for neonatal abstinence syndrome.

Parents of affected infants often belong to the following groups prone to drug addiction:

• Adolescents under 25;
• Unemployed, low-income individuals;
• Those experiencing emotional distress or major trauma;
  ** Low education level;
• Family or parental conflict, disharmony, or overindulgence;
• Prostitution or promiscuous behavior;
• Entertainment or performing arts industry workers;
• Individuals with HIV or sexually transmitted diseases.

##Is Neonatal Abstinence Syndrome Caused by Drugs Used in Painless Childbirth?
There is no definitive conclusion yet, but studies suggest that medications used in painless childbirth may contribute to neonatal abstinence syndrome.

DIAGNOSIS

How is neonatal abstinence syndrome diagnosed?

Due to the lack of specificity in clinical manifestations, the diagnosis mainly relies on the mother's medication history during pregnancy and the baby's clinical symptoms, while excluding other diseases.

What tests are needed for diagnosing neonatal abstinence syndrome? Why?

If neonatal abstinence syndrome is suspected, further details about the mother's medication use during pregnancy should be obtained. Tests may include analyzing the mother's and baby's blood or urine for drugs or their metabolites, as well as toxicology screening of the baby's hair, fingernails/toenails, umbilical cord blood, or meconium. Additionally, tests such as EEG, head CT or MRI, blood glucose monitoring, serum electrolytes, thyroid function, and chest X-rays are needed to rule out other conditions.

Which diseases can neonatal abstinence syndrome be easily confused with? How to differentiate them?

Neonatal abstinence syndrome can be easily confused with the following conditions:

Neonatal hypoxic-ischemic encephalopathy, intracranial hemorrhage, hypoglycemia, hypocalcemia, hypomagnesemia, hyperthyroidism, sepsis, and lung diseases.

Differentiation can be made based on medical history and relevant tests. For example, neonatal hypoxic-ischemic encephalopathy often has a history of prenatal or perinatal asphyxia; intracranial hemorrhage can be confirmed by head CT or MRI; blood glucose and serum electrolyte tests can identify hypoglycemia, hypocalcemia, or hypomagnesemia; thyroid function tests can distinguish hyperthyroidism; blood cultures and inflammatory markers such as procalcitonin and C-reactive protein can help diagnose sepsis; and chest X-rays or CT scans can confirm lung diseases.

TREATMENT

Which department should I visit for neonatal abstinence syndrome?

If you suspect or have confirmed that your baby has neonatal abstinence syndrome, you should seek inpatient examination and treatment in the neonatology department of a regular hospital. In hospitals without a neonatology department, pediatric inpatient care can also be provided.

Can neonatal abstinence syndrome resolve on its own?

Neonatal abstinence syndrome, regardless of severity, will not resolve on its own and requires proper treatment. Otherwise, it may lead to more severe complications or consequences.

Does neonatal abstinence syndrome require hospitalization? How is it treated?

Because the progression of neonatal abstinence syndrome lacks specific patterns, those diagnosed or suspected of having it should be hospitalized for examination and treatment as soon as possible.

Generally, treatment is not initiated before symptoms appear. The treatment plan varies depending on the timing of onset, severity, and progression. Treatment methods include two main aspects:

• Symptomatic and supportive care: For example, providing a quiet, comfortable, and dimly lit environment, swaddling the baby tightly, avoiding auditory, visual, and tactile stimulation, gentle and focused nursing care, timely soothing, rooming-in with the mother, etc.; ensuring sufficient caloric intake, feeding small frequent meals or using tube feeding or intravenous nutrition if feeding is difficult, encouraging breastfeeding if there are no contraindications; administering fluids for vomiting, diarrhea, dehydration, or electrolyte imbalances. These measures can effectively alleviate symptoms in mild and some moderate cases.
• Medication: Severe cases or those unresponsive to supportive care require drug therapy. Commonly used medications include morphine, methadone, clonidine, phenobarbital, and diazepam. Once the desired effect is achieved, the dosage can be gradually reduced and discontinued after 72 hours. Earlier treatment leads to better outcomes.

What are the common side effects of medications for neonatal abstinence syndrome?

Side effects vary by drug but commonly include allergies, rashes, drowsiness, fatigue, constipation, difficulty urinating, respiratory depression, hypotension, sweating, addiction, irritability, and withdrawal syndrome. Clinical use requires doctors to weigh the risks and benefits.

Is the treatment for neonatal abstinence syndrome effective? Can it be completely cured?

The earlier the treatment, the better the outcome for neonatal abstinence syndrome. It is a condition that can be fully cured.

DIET & LIFESTYLE

What should patients with neonatal abstinence syndrome pay attention to in their diet?

Breastfeeding is encouraged for babies with neonatal abstinence syndrome, but breastfeeding is not recommended if the mother has any of the following conditions:

• Did not receive prenatal care;
• Used addictive drugs within 30 days before delivery;
• Continues to abuse addictive drugs or refuses withdrawal treatment;
• Mother's urine toxicology test was positive at delivery.

What should patients with neonatal abstinence syndrome pay attention to in daily life?

After discharge, infants with neonatal abstinence syndrome should avoid re-exposure to addictive drugs. Family members and caregivers should show love and care, monitor the baby's feeding, urination, defecation, and mental responses, track weight gain, and seek medical attention promptly if abnormalities are found.

Does neonatal abstinence syndrome require follow-up? How is it conducted?

After discharge, the baby needs regular follow-ups. There are no strict guidelines on the assessment schedule, but based on personal experience, it is recommended to evaluate every 1–2 months for the first six months, every 3 months from six months to one year, and every six months after one year.

Assess the baby's motor and cognitive abilities, check for developmental deformities, hyperactivity, impulsivity, attention deficits, poor academic performance, and other behavioral issues. Regular ophthalmological evaluations are also needed to detect early signs of nystagmus, strabismus, refractive errors, and other visual impairments. Monitor for growth delays and short stature. Additionally, rule out continued maternal drug use and child abuse.

Does neonatal abstinence syndrome affect fertility?

Some addictive drugs may cause fetal reproductive system malformations, but there is currently no evidence suggesting that neonatal abstinence syndrome affects fertility.

How should family members care for a baby with neonatal abstinence syndrome?

Families of infants with neonatal abstinence syndrome need more social and familial support and care. Provide health education to prevent re-exposure to addictive drugs for both mother and child. Assist with employment, offer medical access, provide psychological support, alleviate anxiety and concerns, and treat any mental or physical health issues.

PREVENTION

Can Neonatal Abstinence Syndrome be Prevented? How to Prevent It?

This condition is entirely preventable. The key lies in early screening, identification, and effective interventions. Pregnant women addicted to substances should receive appropriate treatment. Strengthen education on the dangers of addictive drugs, particularly for women of marriageable and childbearing age, to raise awareness of self-protection and encourage staying away from addictive substances.

How to Prevent Relapse of Neonatal Abstinence Syndrome?

Relapse can be avoided if the mother undergoes treatment and abstains from addictive substances, ensuring the child is not re-exposed to them.

How Can Patients with Neonatal Abstinence Syndrome Prevent Complications?

Balanced nutrition and regular evaluations are crucial measures to prevent complications.