Author: Samantha Bothwell, MA

Neonatal abstinence syndrome can occur in babies exposed to opioids while in the womb.¹ From 2010 to 2017, the number of pregnant people with opioid misuse or opioid use disorder increased by 131%.² As a result, the number of babies born with neonatal abstinence syndrome increased 82%.² However, medication-assisted treatment, such as methadone, can help pregnant people quit misusing opioids and reduce the risk to their unborn child. Plus, medical care can help manage neonatal abstinence syndrome and stabilize newborns.

In this article:

• What is Neonatal Abstinence Syndrome?
• Symptoms of Neonatal Abstinence Syndrome
• How is Neonatal Abstinence Syndrome Diagnosed?
• Neonatal Abstinence Syndrome Treatment
• What Are the Long-Term Effects of Babies Born Addicted to Opiates?
• Receiving Medication-Assisted Treatment During Pregnancy
• How Can I Find Medication-Assisted Treatment?

What is Neonatal Abstinence Syndrome?

Neonatal abstinence syndrome is a cluster of problems or symptoms occurring in babies repeatedly exposed to opioids while in utero. Examples of opioids include prescription painkillers and illegal opioids, such as:

• Heroin
• Fentanyl
• Oxycodone
• Hydrocodone
• Morphine
• Tramadol
• Methadone
• Codeine
• Buprenorphine

When a pregnant person repeatedly uses these substances during the last few weeks of their pregnancy, the baby also becomes dependent on them. Drug dependency means that your body requires the substance to function normally.³ If you are dependent on a drug and stop using it, you will experience withdrawal symptoms.³ The same is true for babies.² Babies may experience opioid withdrawal symptoms after birth as their body adjusts to not having opioids.¹

Symptoms of Neonatal Abstinence Syndrome

Symptoms typically begin within one to three days after birth. However, sometimes symptoms don’t show up for a week.¹ The symptoms a baby born with neonatal abstinence syndrome may experience after birth depend on a few factors, including:¹

• The type of drug the pregnant person was using
• Genetics: Each person’s body breaks down and detoxes from drugs differently
• How much of the drug the baby was exposed to during pregnancy
• How long the pregnant person used the drug
• Whether the baby was born early or full-term

Symptoms of neonatal abstinence syndrome include:¹

• Blotchy skin
• Diarrhea
• Excessive crying or high-pitched crying
• Excessive sucking
• Fever
• Hyperactive reflexes
• Increased muscle tone
• Irritability
• Poor feeding
• Rapid breathing
• Seizures
• Sleep problems
• Slow weight gain
• Stuffy nose, sneezing
• Sweating
• Trembling
• Vomiting

How is Neonatal Abstinence Syndrome Diagnosed?

Diagnosis can be made based on a pregnant person’s drug history, a baby’s symptoms, or certain medical tests and exams. For example, a doctor may ask for a sample of the parent’s urine to test for opioids. Other tests include:¹

• NAS scoring system, which is an assessment of the baby’s symptoms to scale for severity
• ESC (Eat, Sleep, Console) evaluation
• Drug screening of the infant’s urine, first bowel movement, or umbilical cord

Neonatal Abstinence Syndrome Treatment

Neonatal abstinence syndrome treatment can include a few different services. Treatment will depend on what drugs the gestational parent was using, the infant’s overall health, and whether the baby was born early or full-term.¹
Treatment can include:¹

• Medical supervision: Medical supervision may last a week or longer depending on the baby’s unique needs and how severe their symptoms are. Medical staff will be looking to assess for withdrawal symptoms, feeding issues, and weight gain.
• Tender Loving Care (TLC): Babies born with neonatal abstinence syndrome can be difficult to soothe and may cry a lot. TLC includes gently rocking the baby, reducing noise and lights, skin-to-skin contact with the gestational parent, and breastfeeding if possible.
• Medication for withdrawal symptoms: Some babies with severe withdrawal symptoms may require medication to reduce these symptoms. Methadone is another type of opioid that is used to treat opioid misuse and opioid use disorder. Over time, the dose would be reduced to minimize withdrawal symptoms and support the baby while they wean off the drug.
• Nutritional support: Babies with neonatal abstinence syndrome sometimes have problems with eating, so adjusting feeding techniques or methods can help by giving them high-calorie feedings or smaller feedings more often.

How long a baby may need treatment for neonatal abstinence syndrome may vary depending on their needs, but treatment can last up to six months.¹

What Are the Long-Term Effects of Babies Born Addicted to Opiates?

Neonatal abstinence syndrome treatment is effective in treating opioid withdrawal symptoms in babies.¹ When it comes to the long-term effects of babies born addicted to opiates, research shows that babies can fully recover.

The risk of long-term complications is minimal, though one study suggested children with neonatal abstinence syndrome were more likely to have a language or speech impairment or development delay compared to children without this condition; however, more research is needed, as causation between opioid exposure and these delays could not be proved, especially given so many other influences like other environmental or genetic influences.⁴

The type of treatment your baby receives will depend on how severe their symptoms are, but there are treatment options. You and your baby can recover from the effects of opiates.

Receiving Medication-Assisted Treatment During Pregnancy

If you are pregnant and experiencing signs or symptoms of opioid misuse or opioid use disorder, it can be intimidating to seek help. There can be a lot of stigmas that come with having an opioid use disorder, especially during pregnancy.⁵ However, treatment can help you recover from opioid addiction and prevent or mitigate the risks of neonatal abstinence syndrome.

Research shows that medication-assisted treatment (MAT) during pregnancy is safe and effective.^5,6 MAT uses either methadone or buprenorphine to treat opioid use disorder. While these medications are opioids themselves, they are less risky than opioids of misuse, such as heroin or fentanyl.

You may have been in MAT before getting pregnant. It’s important not to stop using these medications during pregnancy, even though they are opiates. It’s possible that these medications can also cause a baby to develop neonatal abstinence syndrome. Still, it’s not nearly as severe as a baby who is exposed to more potent opiates, such as heroin.⁵

Medication-assisted treatment (MAT) is an evidence-based treatment approach for opioid use disorder or opioid addiction. Starting or continuing with MAT during pregnancy is a safer option because it reduces the likelihood that you will relapse and reduces the risk of your baby developing severe symptoms as a result.^5,7 MAT is shown to be the leading treatment approach for pregnant people with opioid use disorder.⁵

MAT includes taking medication that helps manage withdrawal symptoms and help you stop using opioids that can be harmful to you and your baby. Not only is this beneficial for you, but it is also shown to be helpful for your baby.⁷ MAT can help reduce the risk of relapse, birth defects, or low birth weight.⁷

Benefits of Methadone and Buprenorphine During Pregnancy

Methadone and buprenorphine are the medications used to treat opioid misuse and opioid use disorder.⁵ Methadone works to reduce cravings for opioids and withdrawal by blocking the desired effects of opioid use.⁸ Similarly, buprenorphine suppresses and reduces cravings for opioids and withdrawal symptoms.⁷
There are many benefits to MAT during pregnancy, including:⁵

• Improving long-term health outcomes for the pregnant parent and baby
• Stabilizing fetal levels of opiates can reduce withdrawal symptoms
• Improving access for the pregnant parent to receive prenatal care and treatment for other medical issues that can be transferred to the baby, such as HIV or hepatitis
• Lower risk of neonatal abstinence syndrome
• Less severe neonatal abstinence syndrome
• Shorter treatment time
• Increased risk of being born full-term
• Decreased risk of relapse

How Can I Find Medication-Assisted Treatment?

There are a few ways to go about getting MAT during or after pregnancy. There are laws governing who can provide this type of treatment. Different types of clinics offer MAT during or after pregnancy, such as:

• Hospitals
• Inpatient rehab facilities
• Intensive outpatient programs and partial hospitalization programs
• Outpatient methadone clinics

You can speak with a doctor or mental health professional to get a referral to MAT programs. It’s also possible to get a referral from your insurance provider. You can call your insurance to ask for a list of in-network MAT providers.

If you are pregnant and think you could benefit from medication-assisted treatment, please call 800-934-1582(Who Answers?) to speak with a treatment specialist. We can help you find the right program.

Resources

1. National Library of Medicine. (2019, July 29). Neonatal abstinence syndrome.
2. Centers for Disease Control and Prevention. (2021, July 16) Data and Statistics About Opioid Use During Pregnancy.
3. National Library of Medicine. (2021, August 2) Opioid Misuse and Addiction.
4. Centers for Disease Control and Prevention. (2021). About Opioid Use During Pregnancy.
5. National Institute on Drug Abuse. (2017, July). Treating Opioid Use Disorder During Pregnancy.
6. Substance Abuse and Mental Health Services Administration. (2022, March 4). Methadone.
7. Substance Abuse and Mental Health Services Administration. (2022, March 4) MAT Medications, Counseling, and Related Conditions.