Neonatal abstinence syndrome

Question 1

What is NAS?

Answer 1

Withdrawal symptoms that happen in the neonates of mothers who used substances during pregnancy.

Question 2

What substances can cause NAS?

Answer 2

Opiates, methadone, benzodiazepines, alcohol, cocaine, amphetamines, nicotine or cannabis, and SSRI antidepressants.

Question 3

What is poor neonatal adaptation syndrome (PNAS)?

Answer 3

Used to describe withdrawal features in the newborn associated with maternal use of antidepressants, particularly SSRIs.

Question 4

How soon after birth do symptoms occur?

Answer 4

• withdrawal from most opiates, diazepam, SSRIs and alcohol occurs between 3-72 hours after birth
• withdrawal from methadone and other benzodiazepines occurs between 24 hours and 21 days

Question 5

What are CNS signs and symptoms of NAS?

Answer 5

Irritability, increased tone, high pitched cry, not settling, tremors, and seizures.

Question 6

What are vasomotor and respiratory signs and symptoms of NAS?

Answer 6

Yawning, sweating, unstable temperature and pyrexia, and tachypnoea.

Question 7

What are metabolic and GI signs and symptoms of NAS?

Answer 7

Poor feeding, regurgitation or vomiting, hypoglycaemia, and loose stools with a sore nappy area.

Question 8

What should be done for mothers who are known to use substances before giving birth?

Answer 8

An alert on their notes so that when they give birth, the neonate can have extra monitoring and management of NAS.

Question 9

How are babies monitored after birth?

Answer 9

• kept in hospital with monitoring on a NAS chart for at least 3 days (48 hours for SSRIs) to monitor for withdrawal symptoms
• urine sample can be collected from the neonate to test for substances
• support them in a quiet and dim environment with gentle handling and comforting

Question 10

What are medical treatment options for moderate to severe symptoms of NAS?

Answer 10

• oral morphine sulphate for opiate withdrawal
• oral phenobarbitone for non opiate withdrawal
• Gradually wean neonates off oral treatment
• SSRI withdrawal doesn’t typically need or benefit from medical treatment

Question 11

What are some additional considerations for managing NAS?

Answer 11

• testing for hep B and C and HIV
• safeguarding and social service involvement
• safety net advise for readmission if withdrawal signs and symptoms occur
• follow up from paeds, social services, HVs and the GP
• support for the mother to stop using substances
• check the suitability for breastfeeding in mothers with substance use