Symptoms of Neonatal Abstinence Syndrome

Signs and symptoms of Neonatal Abstinence Syndrome (NAS) usually begin anywhere within 24 hours to 7 days after birth depending on what substance was used by the mother.

The Neonatal Abstinence Syndrome Scoring System (click here) lists signs and symptoms that are monitored to score the severity of NAS. The percentage of infants that experience specific symptoms is poorly reported as research on this condition has only recently received focused attention. However, more severe symptoms have been more closely monitored and it is reported that 2-11% of infants with NAS experiencing seizures and over 30% experiencing ECG abnormalities.While individual infant responses to NAS may vary on the type(s) of drugs used by the mother, some of the most common include tremors, irritability (difficulty being comfortable), excessive crying, high pitched crying, sleep problems, vomiting, diarrhea and poor feeding (Hudak, Tan, The Committee on Drugs, & The Committee on Fetus and Newborn, 2012). Below are video examples of some of these common symptoms.

Tremors - these are sometimes mistaken as shivering, but notice the infants often pull their hands to their mouths while their legs show a kicking action.

Cry- While all babies cry, the NAS cry is very distinct because it is usually high-pitched and often occurs even when the babies are being consoled by swaddling, feeding, or holding. 

Overall, these symptoms show that infants experiencing NAS suffer greatly during their withdrawal. The majority of these symptoms can have dangerous effects on the infant. Decreased sleep, ineffective feeding, seizures, fever, abnormal respiratory rate, vomiting and diarrhea all can have severe negative outcomes for the infant as they begin the first few days of their new life. As was mentioned in earlier posts, most infants diagnosed with NAS end up staying in the NICU during recovery, and their length of stay is on average longer than infants who stay in the NICU for other reasons (Tolia, Patrick, Bennett, Murthy, Sousa, Smith, Clark, & Spitzer, 2015). Supervised recovery under the care of medial professionals is the only safe way to help an infant through these dangerous symptoms. Next week's blog will go into more detail on what NAS recovery looks like.

References

Hudak, M., Tan, R., The Committee on Drugs, & The Committee on Fetus and Newborn. (2012) Neonatal drug withdrawal. Pediatrics, 129(2), 540-560. doi: 10.1542/peds.2011-3212

Tolia, V., Patrick, S., Bennett, M., Murthy, K., Sousa, J., Smith, B., Clark, R., & Spitzer, A. (2015). Increasing incidence of the neonatal abstinence syndrome in U.S. neonatal ICUs. The New England Journal of Medicine, 372(22), 2118-2126.