Neonatal abstinence syndrome (NAS) is a term for a group of problems a baby experiences when withdrawing from exposure to narcotics. It is a concern because when a mother uses illicit substances, she places her baby at risk for many problems.
Most neonatal clinicians are acutely aware of the increase in neonatal abstinence syndrome: a nationwide increase from 7/1000 births in 2004 to 27/1000 births in 2013 is reported. Here in California, about 1,190 newborns were diagnosed with drug withdrawal syndrome in 2014, up more than 50 percent from a decade earlier.
Symptoms of withdrawal in full-term babies may include:
- Tremors (trembling)
- Irritability (excessive crying)
- Sleep problems
- High-pitched crying
- Tight muscle tone
- Hyperactive reflexes
- Yawning, stuffy nose, and sneezing
- Poor feeding and suck
- Fever or unstable temperature
The cost of care for infants with NAS is quite hight as many of them are admitted to the NICU for withdrawal symptoms and associated care. The length of stay is 16.4 days, comparing with an average 3.3 days of stay for healthy infants. A 2015 study cites more frequent readmissions for these infants. Researchers found these infants were 2.5 times more likely to be readmitted within 30 days than healthy infants.
The current standard care for narcotics-exposed infants involves limiting exposure to lights and noise, promoting clustering of care to minimize handling and promote rest, swaddling and holding the infant, and providing opportunities for non-nutritive sucking. These soothing techniques, though commonly used to comfort infants, have not been evaluated in relation to such outcomes as the severity of the neonatal abstinence syndrome or the length of the hospital stay.
The strongest evidence from systematic reviews for improving outcomes is in support breastfeeding, with emerging evidence that favors rooming-in. Studies have consistently shown that infants with NAS who are breastfed tend to have less severe symptoms, require less pharmacologic treatment, and have a shorter length of stay than formula-fed infants. Breastfeeding should there for be encouraged for mothers who are stable and receiving opioid-substitute treatment, unless there are contraindications, such as HIV infection or concurrent use of illicit substances. Similarly, emerging evidence suggests that babies who stay in the room with their moms have a shorter hospital stay and duration of therapy and are more likely to be discharged home with their moms. Rooming-in has also been associated with improved breastfeeding outcomes, enhanced maternal satisfaction, and greater maternal involvement in the care of the newborn.
The increased incidence of the NAS and soaring increased in associated health care costs warrant a consistent and comprehensive approach to mitigating the negative outcomes for affected infants, their mothers, and the health care system. Recent innovations in management include standardized protocols for treatment, which have positive effects on important outcomes such as the duration of opioid treatment, the length of the hospital stay, and the use of empirically based dosing protocols. Breastfeeding and rooming-in are promising nonpharmacologic strategies that may also improve outcomes for babies and moms.