Babies at risk of Neonatal Abstinence Syndrome (NAS)

What is Neonatal Abstinence Syndrome (NAS)?

Neonatal Abstinence syndrome (NAS) refers to symptoms that babies may have if their mother used certain drugs during pregnancy; this is often referred to as ‘withdrawal’.

This page contains information about how to:

• To understand and recognise withdrawal symptoms
• Understand the baby’s needs

It is important that you understand the facts so you can be confident in caring for the baby.

Most substances (including medication, tobacco and alcohol) taken in pregnancy will pass through the placenta and be absorbed by baby. This in turn can cause physical dependency and the baby may become dependent on these medications as well.

After delivery when the umbilical cord has been cut the supply of drugs to the baby suddenly stops and the baby may show signs of physical withdrawal known as Neonatal Abstinence Syndrome (NAS).
This withdrawal process is similar to that experienced by an adult who suddenly stops taking medication.
Most babies exposed to drugs during pregnancy will experience some symptoms of withdrawal however, some may require no different care to any other baby.
Withdrawal symptoms usually start within two to three days of birth, although some start sooner and others after one to two weeks. Some babies may require more specialist care and need medications to help them as they withdraw.

It will be necessary to monitor baby at home for signs of withdrawal, you will be given a withdrawal form and instructions how to complete this. You will need to complete a training checklist for NAS with the nurse caring for the baby.

The Neonatal Community Nurses will see you and baby at home and will be a point of contact if you have any concerns.

Signs and symptoms of NAS and what you can do to help

Neonatal withdrawal symptoms include:

• A continuous high pitched cry
• Shaking (tremor) of arms and legs whether disturbed or resting
• Irritability and restlessness and scratching of their face
• Increased muscle tone (where the limbs feel stiff)
• Excessive wakefulness (not sleeping or settling after a feed)
• Feeding difficulties, coordination of sucking and swallowing, and/ or frantic sucking
• Poor weight gain
• Sickness / vomiting
• Diarrhoea
• Fever (high temperature)
• Sweating
• Fast breathing (tachypnoea)
• Excessive sneezing, yawning, hiccups
• Less commonly fits (convulsions)

Below are some suggestions on how you can help baby depending on their symptoms but whenever you are in doubt, ask for help.

1. Excessive crying, tremors, irritable or restless, tense, stiff arms and legs, sleeplessness (cannot settle after a feed).

Keep the baby in a quiet room with no bright lights and avoid excessive handling.
You can wrap the baby in a sheet and gently rock him/her, but be careful not to make the baby get too hot and keep clothing to a minimum.
Some babies can suck their fists excessively and cannot settle even after a feed. In these situations dummies may be helpful as they may be comforting to a baby withdrawing from drugs. Also cover baby’s hands with gloves or mittens if the skin becomes damaged from too much fist sucking. Make sure baby has a clean, dry nappy

2. Feeding difficulties

Feed baby on demand in a quiet place with minimal disruption. Small frequent feeds are often better tolerated. You can also keep a record of feeds for the Midwife or health visitor to check if baby if feeding enough.

3. Skin problems, including nappy rash

Check and change baby’s nappy regularly as sometimes baby can have runny stools and may
develop a nappy rash.

4. Sneezing, snuffly nose and breathing problems

Keep baby’s nose and mouth clean and make sure no-one smokes near baby.

Avoid overdressing or wrapping baby too tightly as this may restrict chest movements.

Avoid putting baby on his /her tummy to sleep. Keep a close watch on baby, if breathing difficulties worsen or continue see advise GP, Midwife, health visitor or call 999.

Once you are home it is important that you do not smoke in the house or near baby.

The Lullaby Trust has information on safe sleeping.
Sudden Infant death syndrome (SIDS) is the unexpected and unexplained death of a baby or child. It is important you do not share a bed with baby as this will increase the risk.
SIDS is rare but the risk increased in babies whose mothers took drugs in pregnancy.

SEEK MEDICAL HELP IMMEDIATLEY BY DIALLING 999 if baby

• Stops breathing and goes blue
• Is struggling for breath
• Is unconscious or seems unaware of what is going on
• Will not wake up, or
• Has a fit for the first time, even if they seem to recover

Medication weaning process

Baby may be discharged home still requiring treatment for withdrawing. The medication will be gradually reduced over time and not stopped suddenly. Weaning may take a few days to several weeks.
The doses will be documented on the prescription chart and only that dose can be given at the specified time. You will be required to sign the chart when the medication has been given and the prescription chart will be returned to the hospital when all medication has been given to be filed in baby’s medical records.

If the symptoms appear to be increasing then to liaise with neonatal Community Nurses who will liaise with medical staff to discuss.

Correct storage of medication

The medication will need to be stored appropriately and this will be explained to you prior to discharge.
Any medication left can be taken to the local pharmacy to be discarded appropriately.
The clinical skills list is included in this leaflet and the nursing/medial staff will ensure that the foster carers are fully trained prior to baby being discharged home.

Contact numbers

Diana, Princess of Wales Hospital, Grimsby, Looked After Children team – 03033 305383

Scunthorpe General Hospital, Looked After Children team – 03033 305863