Neonatal Abstinence Syndrome

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Neonatal Abstinence Syndrome is a condition where babies experience withdrawal symptoms following the use of addictive illicit or prescription drugs either by the mother or when these drugs are prescribed for the baby itself. Most commonly, it is due to the use of opioids, but other drugs can also lead to this condition.

Neonatal abstinence syndrome is a withdrawal symptom in babies caused due to the use of drugs such as opioids, methadone, barbiturates, fentanyl, diazepam or other narcotics.

Neonatal Abstinence Syndrome

There are two types of neonatal abstinence syndrome. The first type is Prenatal, that is, it occurs due to use of drugs by the mother during pregnancy. The foetus becomes drug dependant and experiences withdrawal symptoms after birth, when exposure to the drug is suddenly stopped.

The second category is Postnatal which follows the use of drugs for the baby in situations like emergency mechanical ventilation that requires analgesia. Fentanyl is the most common analgesic used in newborns; It can cause neonatal abstinence syndrome if it is suddenly stopped.

Drugs which are frequently implicated in the occurrence of Neonatal Abstinence Syndrome include:

• Benzodiazepines
• Opioids
• Amphetamines
• Barbiturates
• Heroin
• Methadone
• Oxycodone
• Cocaine
Neonatal Abstinence Syndrome: Cocaine

• Marijuana (pot)
• SSRI’s(Selective Serotonin Reuptake Inhibitors) -

Symptoms of Neonatal Abstinence Syndrome

Symptoms present within first two days after birth in case of the prenatal type, but might even present 10 days after birth. They can last from 1 week to 6 months after birth depending on the severity of the exposure of the baby in the womb. Symptoms of neonatal abstinence syndrome can be categorized into three classes depending upon the system affected. The following are the different systems affected.

Symptoms related to Brain or Central Nervous System:

1. Excessive high pitched cry

Neonatal Abstinence Syndrome: Cry

2. Seizures Irritability

3. Increased muscle tone

4. Sleep problems

5. Tremors

Symptoms related to Gastrointestinal System:

1. Vomiting

Neonatal Abstinence Syndrome: Vomiting

2. Diarrhea Poor feeding

3. Poor weight gain

4. Excessive sucking

5. Dehydration

Symptoms related to Autonomic Nervous System:

1. Fever

Neonatal Abstinence Syndrome: Fever

2. Slightly elevated respiratory rate and blood pressure

3. Excessive sweating

4. Piloerection or standing up of hair

Long Term Complications

Apart from withdrawal symptoms in the infants, there are the possibilities of developing other complications due to exposure of the drug in the mother’s womb -

• Birth defects
• Learning disabilities
• Low IQ
• Growth retardation

One has to also remember that in pregnant women who indulge in drug abuse, the chances of using multiple drugs is fairly common. Hence, the risk of developing growth complications is higher. Other risks in such mothers include passing on HIV/AIDS infection to their babies, more so if they are IV drug abusers.

Preterm babies experience withdrawal symptoms of lesser severity due to smaller duration of exposure to drugs in comparison to full term or near term babies.

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