Neonatal Abstinence Syndrome - Causes, Symptoms, Complications and Treatment

Introduction:

Neonatal abstinence syndrome is also known as neonatal withdrawal syndrome and neonatal passive addiction. It is the result of the sudden discontinuation of the drugs the mother abused during her pregnancy. However, the drug supply stops when the baby is born, and the child goes through withdrawal symptoms until the drugs are in the system. The newborns receive addictive drugs and substances through the placenta. Babies feel withdrawal symptoms for a few weeks after birth. There are various treatment plans present for the well-being of the child.

What Is Neonatal Abstinence Syndrome?

The placenta is an organ that provides nutrients and oxygen to a growing child from the mother's body in the uterus. If the mother is exposed to drugs or addictive substances, it passes to the child through the placenta. Neonatal abstinence syndrome is when signs and symptoms of drug withdrawal are seen in newborn babies, followed by postnatal or in-utero exposure to the drugs.

What Are the Types of Neonatal Abstinence Syndrome?

Following are the two types of Neonatal Abstinence Syndrome.

• Prenatal Neonatal Abstinence Syndrome: It is caused by maternal use of substances, resulting in babies' withdrawal symptoms.

• Postnatal Neonatal Abstinence Syndrome: It is caused by the secondary discontinuation of certain medications such as morphine.

What Are the Causes of Neonatal Abstinence Syndrome?

If the mother takes certain medications or substances during pregnancy, it passes from the bloodstream to the child through the placenta. At the time of birth, the child becomes addicted to the drugs, and after the delivery, there is no more prolonged exposure to drugs the child starts manifesting specific withdrawal symptoms.

Following are the certain drugs that cause neonatal abstinence syndrome.

• Nicotine is present in cigarettes.

• Antidepressants such as Barbiturates and alcohol use during pregnancy.

• Use of certain central nervous system stimulants such as cocaine during pregnancy.

• Opioid analgesics present is prescribed medication such as codeine.

• Anesthetics are more commonly used in neonatal intensive care units, such as Fentanyl and Morphine.

How Long Does Neonatal Withdrawal Last?

Symptoms usually appear one to seven days after birth. Symptoms can be mild or severe, but they usually go away by the time a baby is six months old. The sign and symptoms of neonatal abstinence syndrome depend upon the type of drug, duration of drug usage, and gestational period.

Following are the signs and symptoms of neonatal abstinence syndrome.

• The child cries with a loud high pitched tone.

• The child is cranky, shaky, and restless.

• The child feels difficulty sleeping.

• The body of the child appears to be stiff.

• There is the presence of fever, vomiting, and frequent stools.

• There is the presence of excessive sweating and diaper rashes.

• The child shakes or trembles in a jerky way.

• There is a startle reflex.

• The children have stuffy noses and sneeze a lot.

• The child has trouble breathing.

• The child yawns a lot.

• The skin appears to be a blotchy and marble-like pattern.

• There is a feeding problem and difficulty in gaining weight.

• There is the presence of overactive reflexes and hypertonia.

What Are the Complications of Neonatal Abstinence Syndrome?

The child suffering from neonatal abstinence has various complications after birth. First, the newborn is admitted to the intensive care unit until the drugs leave their body. If the child has large amounts of drugs in their body, they are at high risk of a life-threatening condition.

Following are the various complications of neonatal abstinence syndrome.

• Premature birth of the child and low weight.

• Jaundice.

• Sudden infant death syndrome.

• Seizures.

• Delay in developmental milestones.

• Behavior problems and delayed learning skills.

• Difficulty in motor skills.

• Impaired speech and language.

• Impaired vision

• Ear infections.

• Slow growth.

How is Neonatal Abstinence Syndrome Diagnosed in Babies?

The diagnosis of neonatal abstinence syndrome is based on the type and duration of the drug used by the mother during pregnancy.

Following are the diagnostic tests.

• Neonatal Abstinence Syndrome Scoring - Pediatrics use scores according to the severity of withdrawal symptoms in this scoring system. The treatment of the baby is done according to the score.

• Drug Screening: Drug screening takes blood, urine, and umbilical cord samples.

• Meconium Test: It is an examination of a newborn's bowel movement.

What Is the Treatment Plan for Neonatal Abstinence Syndrome?

The treatment plan depends upon the type of drug, quantity, and duration. Treatment is done for five months. Treatments help in reducing long-term symptoms. Following are the treatment plans for neonatal abstinence syndrome.

1. Medications - These help in managing severe withdrawal symptoms seen in children. It helps to alleviate withdrawal symptoms and allows them to eat and sleep. Medicines that are given to reduce withdrawal symptoms are,

   1. Morphine.

   2. Methadone.

   3. Phenobarbital.

   4. Clonidine.

   5. Buprenorphine.

2. Intravenous Fluid - The child gets fluid intake to prevent the baby from dehydrating. Due to diarrhea and vomiting, there is fluid loss in the child.

3. Weight Gain - The parents are advised to feed their babies a high-calorie diet to help them grow.

How Can Parents Comfort Their Children?

During treatment, the child becomes restless and fussy. Therefore, parents should soothe their children.

Following are a few instructions to calm the child.

• Parents should stay in the same room with their children.

• Parents should be gentle with their children.

• Parents should give kangaroo care, that is, skin-to-skin contact.

• Parents should swaddle their children in a blanket.

• Parents should keep the child's room quiet.

• Breastfeeding should be done.

• Parents can give their children pacifiers.

How is Neonatal Abstinence Syndrome Prevented?

Following are the few prevention measures which can be followed to prevent neonatal abstinence syndrome.

• Avoid taking unnecessary medications during pregnancy.

• The mother should not stop taking prescribed medication and supplements.

• Avoid substance usage during pregnancy.

Conclusion:

Parents should ensure that the child gets proper treatment if the newborn child is diagnosed with neonatal abstinence syndrome. The health care providers and pediatricians should ensure that the child is healthy enough to return home. Parents need to observe and monitor their children properly after returning home. The child needs extra love, care, and support from their parents. Parents should be available and responsible for their children.