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Pregnant Women

Neonatal abstinence syndrome is on the rise. Since 1999, its incidence has tripled in 28 states (from 1.5 to 6 cases per 1,000 live births per year), with the worst rates being in West Virginia, Vermont, and Maine (about 30 case per 1,000 live births).

This syndrome begins in infants soon after they lose access to the addictive drugs delivered in vitro, either when the mother goes cold turkey during pregnancy or when the baby is delivered. Women who become pregnant while they are taking illicit or prescription drugs should discuss with their medical provider how to discontinue drug use safely. At Two Dreams we have a passion for serving all patients and pregnant women are no exception. We offer a safe, compassionate environment in which pregnant women can work through their addictions while learning about the safest methods of treatment for their babies.

What is Neonatal Abstinence Syndrome?

Neonatal abstinence syndrome (NAS) is a group of health problems that occur in newborn infants who have been exposed to addictive drugs, particularly opioids, while in the womb. When the infant stops receiving the drugs or alcohol, it begins experiencing withdrawal symptoms.

Pregnant women who stop taking drugs without consulting their doctor risk severe side effects not only for themselves, but for their unborn babies as well. This cold turkey tactic might lead to stillborn death or preterm birth to an underdeveloped newborn with NAS. The disease can also occur in newborns that are continuously exposed to drugs throughout development in the womb then lose access to drugs upon delivery.

What Drugs Cause NAS?

A majority of NAS cases have been linked to opioids, such as the ones listed.

  • fentanyl (Actiq, Duragesic)
  • codeine
  • hydrocodone (Vicodin)
  • morphine (Kadian, Avinza)
  • oxycodone (OxyContin, Percocet)
  • heroin
  • methadone or buprenorphine

But opioids are not the only drugs that can cause NAS. Pregnant women who drink alcohol excessively or take barbiturates (sleeping pills), antidepressants, or benzodiazepines (tranquilizers) are also at risk for their child developing symptoms of NAS and going through withdrawal.

Why Is Neonatal Abstinence Syndrome so High?

Pregnant women taking opioids are the main contenders of this syndrome. The increase in neonatal abstinence syndrome is likely attributable to the increased prescription rates of opioids in the United States, as well as a general misunderstanding of how pain should be treated.

Remember that knowledge is power; talk to your doctor about your medications and which of the, are safe to take during pregnancy. Seek addiction treatment as needed.

What Are the Symptoms?

Usually one to three days (sometimes as late as one week) after birth or after discontinuing drug exposure, babies with NAS may show some of the following symptoms:

  • Excessive or high pitch crying
  • Excessive sucking

· Poor feeding and slow weight gain

  • Irritability
  • Rapid breathing
  • Fever
  • Diarrhea
  • Twitching and trembling
  • Increased muscle tone
  • Difficulty sleeping
  • Blotchy skin color
  • Sweating
  • Stuffy nose and sneezing
  • Vomiting
  • Seizures

The degree of severity will depend on the type of drug taken and dosage used by the mother, how the body breaks down the drug, and the level of development (whether the baby is preterm or full term). In addition, a number of complications are associated with NAS:

  • Low birth weight
  • Birth defects
  • Premature birth
  • Small head circumference
  • Sudden infant death syndrome
  • Developmental problems
 

 

How Is it Diagnosed?

The infant’s urine or meconium (stool from baby’s first bowel movement) can be tested for the presence of drugs. The infant’s symptoms can be assessed using the neonatal abstinence syndrome scoring system to determine disease severity. Also, physicians can glean information from discussions with the mother about all of the drugs (prescription and illicit) she used and details over the time period taken and the dosage.

How Is NAS Treated?

Treatment depends on the drug that induced NAS, the severity of the syndrome, and the degree of development. Infant symptoms are monitored and treated as appropriate. If they experience dehydration, they may be given intravenous fluid therapy. They often develop skin problems that need to be treated with ointment. Babies with NAS are easily irritated and fair better in dark places with low noise. They also have difficulties feeding, so they may be fed high-calorie formula.

Infants with NAS will often be given low doses of the addictive drugs that the mother took to wean them off the drug and reduce withdrawal symptoms. They may also be given methadone or buprenorphine, but the infants given these treatments typically have severe conditions and will end up staying in the hospital for an extended period of time. Infants with NAS might also have other complications (like birth defects), which need to be addressed and could extend their stay in the hospital. During hospitalization, babies are watched for the resolution of symptoms, improved feeding, and weight gain.

How Long Does It Take to Recover?

Babies receiving treatment recover faster, often within a month, but recovery for NAS has taken as long as six months. When babies leave the hospital, their conditions are stable, but they are usually still sick when they arrive home and require extra attention. Mothers are encouraged to continue the high calorie feeding, calming the baby by rocking and swaddling, reducing their exposure to noise and light, and treating them with skin to skin care.

NAS is a life-threatening condition to newborns. If you are pregnant and have an addiction to an illicit or prescription drug, you should seek help. Call Two Dreams (708-613-4750) today!

Sources:

http://www.marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx

https://medlineplus.gov/ency/article/007313.htm

http://www.cdc.gov/mmwr/volumes/65/wr/mm6531a2.htm

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