Exposure to substances such as caffeine, nicotine, selective serotonin reuptake inhibitors (SSRIs), and opioids can result in varying degrees of withdrawal symptoms, but NAS is most commonly the result of exposure to opioids. Opioids are often used for pain relief/management. Opioids are often distinguished as either “street drugs” like heroin or fentanyl; prescription pain relievers like oxycodone, hydrocodone, codeine, and morphine; or opioid-dependence treatment medications like methadone and buprenorphine.
The primary signs and symptoms of NAS include a combination of:
The presentation of withdrawal symptoms is thought to depend on the type of substance exposure; the frequency, dose, and timing of last exposure; gestational age; maternal metabolism; and maternal use of multiple substances. Symptoms may be present within 24 to 75 hours after birth, but often do not appear until 5 to 7 days after birth. Infants who are showing signs of NAS should receive medical attention.
Secondary conditions that can develop as a result of NAS include:
Withdrawal symptoms can last from weeks to months depending on the timing, duration, and type of substance exposure in the womb. Exposure to substances like nicotine and SSRIs often present as milder symptoms, and polysubstance exposure (being exposed to more than one substance) generally leads to greater withdrawal symptoms. Prolonged exposure in the womb to opioids can lead to more severe symptoms including visual problems, premature birth, and lower birth weight.
Much of the current research specifically focuses on the longer-term outcomes of opioid-related NAS. There is evidence that children born with opioid-related NAS are at risk for having:
The Canadian Paediatric Society recommends that newborns with opioid-related NAS be monitored for a minimum of 72 hours in hospital. Length of stay in hospital depends on the type of substance(s) exposure, severity of withdrawal, symptoms of withdrawal, treatment plan, and home/family circumstances.
In some cases of opioid-related NAS, medications may be given to the infant to reduce symptoms (e.g., morphine, methadone, phenobarbital, clonidine, buprenorphine). In general, there is uncertainty regarding the best medication for treatment of NAS. Some medical professionals and researchers suggest that there should be a balance between providing the least amount of medication while also improving an infant’s weight gain and ability to be consoled.
Some evidence suggests that treating opioid-related NAS with medications can prolong length of hospital stay and disrupt mother-infant attachment. As such, non-medication treatment interventions are recommended, such as:
Based on the available research, when it is safe and feasible, infants with NAS should:
Parents and caregivers of infants with NAS can use many of the recommended in-hospital non-medication treatments such as skin-to-skin contact, safe swaddling, soothing, rooming-in, breastfeeding, and providing a quiet environment with minimal stimulation. It is also important for parents and caregivers to get support if they are feeling overwhelmed. Taking breaks, resting, and going for walks can also be helpful.
Caring for an infant with NAS after hospital discharge should include:
Identifying and treating individuals who may be using substances during pregnancy is essential for identifying infants with or at-risk for NAS. Screening can be as simple as engaging a patient in a brief, non-judgemental conversation about past and current alcohol, illicit substance, and prescription use. Education, support for changing behaviour, and referrals for assessment and treatment should also be provided when required.
Prevention of NAS largely requires infants not to be exposed to substances like opioids in the womb. For individuals with substance use issues and dependency, there are a variety of treatment options. For individuals with opioid-dependence, detoxification or medically assisted withdrawal (e.g., opioid replacement therapy) is recommended.
For individuals with chronic conditions like pain, opioids are commonly prescribed. Alternative pain therapies (e.g., exercise, physical therapy, behavioural approaches) and non-opioid medication treatments can be explored rather than prescribing opioids for pain management.
It is important for women who are pregnant or planning to become pregnant to speak with their healthcare providers about medication use during pregnancy. Women should also speak with their healthcare providers in cases where they may have used substances before they knew they were pregnant.
Stigma related to maternal substance use during pregnancy can negatively affect health outcomes for both mothers and their babies. For example, using stigmatizing language (e.g., drug-dependent mothers, addicted mothers) can discourage women from seeking help for their substance use, and can affect the quality of and access to healthcare services. Stigma and other negative forms of treatment can prevent women from accessing prenatal care. Therefore, it is important that healthcare professionals hold positive, non-judgemental attitudes when caring for mothers of and infants with NAS.
Exposure to substances such as caffeine, nicotine, selective serotonin reuptake inhibitors (SSRIs), and opioids can result in varying degrees of withdrawal symptoms, but NAS is most commonly the result of exposure to opioids. Opioids are often used for pain relief/management. Opioids are often distinguished as either “street drugs” like heroin or fentanyl; prescription pain relievers like oxycodone, hydrocodone, codeine, and morphine; or opioid-dependence treatment medications like methadone and buprenorphine.
The presentation of withdrawal symptoms is thought to depend on the type of substance exposure; the frequency, dose, and timing of last exposure; gestational age; maternal metabolism; and maternal use of multiple substances. Symptoms may be present within 24 to 75 hours after birth, but often do not appear until 5 to 7 days after birth. Infants who are showing signs of NAS should receive medical attention.
Secondary conditions that can develop as a result of NAS include:
Withdrawal symptoms can last from weeks to months depending on the timing, duration, and type of substance exposure in the womb. Exposure to substances like nicotine and SSRIs often present as milder symptoms, and polysubstance exposure (being exposed to more than one substance) generally leads to greater withdrawal symptoms. Prolonged exposure in the womb to opioids can lead to more severe symptoms including visual problems, premature birth, and lower birth weight.
Much of the current research specifically focuses on the longer-term outcomes of opioid-related NAS. There is evidence that children born with opioid-related NAS are at risk for having:
The Canadian Paediatric Society recommends that newborns with opioid-related NAS be monitored for a minimum of 72 hours in hospital. Length of stay in hospital depends on the type of substance(s) exposure, severity of withdrawal, symptoms of withdrawal, treatment plan, and home/family circumstances.
In some cases of opioid-related NAS, medications may be given to the infant to reduce symptoms (e.g., morphine, methadone, phenobarbital, clonidine, buprenorphine). In general, there is uncertainty regarding the best medication for treatment of NAS. Some medical professionals and researchers suggest that there should be a balance between providing the least amount of medication while also improving an infant’s weight gain and ability to be consoled.
Some evidence suggests that treating opioid-related NAS with medications can prolong length of hospital stay and disrupt mother-infant attachment. As such, non-medication treatment interventions are recommended, such as:
Based on the available research, when it is safe and feasible, infants with NAS should:
Identifying and treating individuals who may be using substances during pregnancy is essential for identifying infants with or at-risk for NAS. Screening can be as simple as engaging a patient in a brief, non-judgemental conversation about past and current alcohol, illicit substance, and prescription use. Education, support for changing behaviour, and referrals for assessment and treatment should also be provided when required.
Prevention of NAS largely requires infants not to be exposed to substances like opioids in the womb. For individuals with substance use issues and dependency, there are a variety of treatment options. For individuals with opioid-dependence, detoxification or medically assisted withdrawal (e.g., opioid replacement therapy) is recommended.
For individuals with chronic conditions like pain, opioids are commonly prescribed. Alternative pain therapies (e.g., exercise, physical therapy, behavioural approaches) and non-opioid medication treatments can be explored rather than prescribing opioids for pain management.
It is important for women who are pregnant or planning to become pregnant to speak with their healthcare providers about medication use during pregnancy. Women should also speak with their healthcare providers in cases where they may have used substances before they knew they were pregnant.
Stigma related to maternal substance use during pregnancy can negatively affect health outcomes for both mothers and their babies. For example, using stigmatizing language (e.g., drug-dependent mothers, addicted mothers) can discourage women from seeking help for their substance use, and can affect the quality of and access to healthcare services. Stigma and other negative forms of treatment can prevent women from accessing prenatal care. Therefore, it is important that healthcare professionals hold positive, non-judgemental attitudes when caring for mothers of and infants with NAS.