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 the 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, and the child starts manifesting specific withdrawal symptoms.

Which Drugs Can Lead to Neonatal Abstinence Syndrome?

A newborn may experience neonatal abstinence syndrome (NAS) if their birthing parent consumed drugs (opioids) or other addictive substances during pregnancy. The most common drugs associated with NAS include Amphetamines, Buprenorphine, Codeine, Heroin, Oxycodone, Hydrocodone, Morphine, and Methadone. In addition to opioids, several other substances can cause neonatal abstinence syndrome (NAS) in newborns if consumed by the birthing parent during pregnancy. These substances include alcohol, barbiturates, benzodiazepines, Nicotine, and certain antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs).

Who Is Affected by Neonatal Abstinence Syndrome?

Neonatal abstinence syndrome affects newborns whose birthing parent used or was addicted to opioid drugs or other addictive substances during pregnancy. Drug addiction is a prevalent issue, impacting an estimated 20 million people in the United States.

How Prevalent Is Neonatal Abstinence Syndrome?

Quantifying neonatal abstinence syndrome (NAS) is challenging as the number of cases rises each year. According to one study, a newborn is diagnosed with NAS every 25 minutes, translating to between two to seven newborns per 1,000 births.

What Are the Symptoms of Neonatal Abstinence Syndrome?

Symptoms of neonatal abstinence syndrome include vomiting, diarrhea, fever and sweating, rapid breathing, loud, high-pitched, and excessive crying, frequent sucking, shaking (tremors), and diaper rash. Additional symptoms of neonatal abstinence syndrome may include hypertonia and overactive reflexes, difficulty gaining weight, trouble falling asleep and staying asleep, feeding problems, and a blotchy, marbled pattern on the skin (mottling).

If the child is born with a significant amount of drugs in their system, they may be at risk of experiencing severe, life-threatening symptoms such as premature birth, growth and birth defects, seizures, and sudden infant death syndrome (SIDS).

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 - Pediatricians use scores according to the severity of withdrawal symptoms in this scoring system. The baby is treated 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 a 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 an Individual Help a Newborn Manage Their Symptoms?

The newborn may be fussy and difficult to soothe while experiencing withdrawal symptoms. Parents can help by:

• Staying with the baby as much as possible.

• Swaddling the newborn in a soft blanket.

• Minimizing the newborn’s exposure to loud noises and bright lights.

• Holding the baby close to the chest (skin-to-skin contact).

• Gently rocking the baby.

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.