Neonatal Abstinence Syndrome: Symptoms, Causes & Treatment

Early avoidance of alcohol and drugs can prevent the syndrome and ensure the newborn's good health.

Medically reviewed by Dr. Dur Afshar Agha, MS Dr. Dur Afshar Agha Dr. Dur Afshar AghaMS facebook_iconinsta_icon Specialty: Masters of Tropical PediatricsExperience: 26 years
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Neonatal abstinence syndrome (NAS) is a withdrawal syndrome experienced by babies when they are exposed to harmful substances such as opioids or alcohol in the womb (1). Neonatal opioid withdrawal syndrome (NOWS) is another related term that specifically describes withdrawal from opioids (2).

Babies mostly develop neonatal abstinence syndrome after birth because they no longer receive the drug from their mother. The condition causes them to experience discomfort and undergo withdrawal symptoms until the drug has completely exited their bodies.

Read this post for more information on the causes, symptoms, complications, diagnosis, treatment, and prevention of neonatal abstinence syndrome.

Causes Of Neonatal Abstinence Syndrome

NAS is most often caused due to the intake of certain narcotic drugs such as opioids. However, in some cases, NAS could also occur due to medications, such as antidepressants, barbiturates, or benzodiazepines (present in sleeping pills) (3).

Maternal consumption of the drugs could cause them to pass from the mother’s bloodstream to the fetus via the placenta. If pregnant women use substances that affect their nervous system, it will affect the baby’s nervous system, and they might show signs of withdrawal after birth (4). The substances that may cause neonatal abstinence syndrome in babies include:

  • Opioids, such as heroin and prescribed medicines such as codeine and oxycodone
  • Stimulants, such as amphetamines or cocaine
  • Antidepressant medicines, such as selective serotonin reuptake inhibitors (SSRIs)
  • Depressants, such as alcohol, barbiturates, or marijuana
  • Nicotine from tobacco products, such as cigarettes

Symptoms Of Neonatal Abstinence Syndrome

The signs and symptoms of NAS may vary based on the following factors (5).

  • Drug’s type
  • Concentration of drug per use
  • Frequency of drug use
  • Last dosage of the drug
  • Baby is born premature or full-term

Premature babies may show less severe withdrawal symptoms as they were exposed to lesser concentrations of the drugs during pregnancy than full-term babies.

The symptoms of NAS in full-term babies may include (6) (7):

  • High-pitched crying
  • Tremors or shaking of arms, legs, and face
  • Frequent yawning
  • Overactive sucking during feeding
  • Low birth weight and difficulty in gaining weight after that
  • Fast breathing
  • Trouble falling asleep and staying asleep
  • Stuffy nose and sneezing
  • Vomiting or diarrhea
  • Skin rashes, mostly in the diaper area and face
  • Sweating and dehydration
  • Patchy color of skin

The signs of neonatal abstinence syndrome can vary from one baby to another. For example, some babies may start showing symptoms right after birth, while others may show it 72 hours to a few days later. Therefore, be alert to the symptoms of the syndrome in your baby for a month if you consumed NAS-causing substances during pregnancy. Take your baby to a doctor right away if you suspect they could be showing signs of neonatal abstinence syndrome.

Diagnosis Of Neonatal Abstinence Syndrome

A detailed analysis of the mother’s drug intake and usage history is important for the doctor and healthcare provider to start treating babies with neonatal abstinence syndrome. In addition, a neonatal abstinence scoring system may be used to help diagnose the severity of the withdrawal (8).

The scoring system lets the doctor assign points for certain signs and symptoms, helping determine their severity. Knowing the severity of the signs also helps in planning the treatment procedures for the baby.

Treatment For Neonatal Abstinence Syndrome

The treatment for neonatal abstinence syndrome usually depends on the baby’s age, the symptoms shown by them, and the severity of the disease. Non-pharmacological measures usually treat babies with opioid-dependent syndrome or NAS unless no significant improvement is observed. Then, pharmacological treatment is required (2).

Non-pharmacological treatment measures refer to the procedures where no medicines are administered to the baby.

  • Babies with withdrawal syndrome are usually irritable and do not get comforted easily. Skin-to-skin care, also known as kangaroo care, can help ease the baby and keep them calm. Comforting your baby is important during this time
  • Babies with NAS tend to be very sensitive to bright light and loud noises (5). It is advisable to keep them in a calm and quiet environment
  • Babies with NAS may also need extra calories added to their food as they have an increased rate of activity compared to other babies
  • Certain babies may also need to be administered IV fluids as they are prone to dehydration due to vomiting or diarrhea

If the baby is not showing positive signs of development to the non-pharmacological methods, the doctors might consider medication-assisted treatment.

  • Some babies require medicines to recover from the withdrawal symptoms and prevent further complications, such as a seizure.
  • Certain medicines could also help prevent discomfort and other complications due to withdrawal.

The dosage of any medication could be changed based on the baby’s response to it. Babies who display improvement could have their dosage reduced gradually until it is stopped entirely once the baby has recovered (5).

Complications Of Neonatal Abstinence Syndrome

Fetal exposure to drugs or narcotics may also lead to the following complications in newborns.

  • Developmental delays
  • Premature birth
  • Seizures
  • Jaundice
  • Congenital disabilities (birth defects)

Prevention Of Neonatal Abstinence Syndrome

The only way to prevent neonatal abstinence syndrome is to avoid narcotics, alcohol, nicotine, and other potentially harmful compounds from the preconception phase. If you are on any medication, such as antidepressants, speak to your doctor, who may suggest alternatives.

Several vital body parts develop during the first trimester, making it essential to quit and stay clean right before you conceive (4). If you have trouble quitting addictive substances, you may speak to a counselor or visit your local deaddiction center to find appropriate solutions.

Frequently Asked Questions

1. Can neonatal abstinence syndrome cause death?

According to research, the chances of mortality in babies exposed to drugs before birth were suggested to be 1% (9).

2. How long do withdrawal symptoms last in newborns?

It is difficult to know for how long the symptoms of NAS will last after birth. The length of the withdrawal after birth usually depends on the type of medicines and the treatment being provided. It might take the babies a few days to a few months to recover from it.

3. Do babies with neonatal abstinence syndrome sleep a lot?

Babies with neonatal abstinence syndrome usually have trouble falling asleep or staying asleep for a long time.

4. How long are NAS babies hospitalized?

The symptoms of NAS usually appear one to three days after birth but may take up to a week. Due to this, the baby may be required to stay in the hospital for observation for up to a week (10).

5. How common is NAS?

In the US, around 27 out of 1000 live births have been reported to have neonatal abstinence syndrome (NAS) (11).

6. Why is clonidine given to NAS babies?

Clonidine is a prescription medicine for babies with NAS. Clonidine produces similar effects as some of the drugs causing NAS that the mothers took during pregnancy. When lower doses of the medicine are given over time, eventually, the baby will not need the drug anymore. This prevents withdrawal symptoms such as stiffness, shaking, and agitation (12).

Neonatal abstinence syndrome happens to babies when exposed to addictive drugs and compounds during the fetal stage. Despite its potential to cause problems, neonatal abstinence syndrome can be easily prevented by avoiding potentially harmful and addictive substances in pregnancy. If you have trouble quitting a substance, speak to a doctor or counselor so that you can avoid any risk of the syndrome right from the preconception phase.

Key Pointers

  • In neonatal abstinence syndrome (NAS), babies experience withdrawal symptoms after birth if their mothers consumed substances such as opioids or alcohol during pregnancy.
  • High-pitched crying, tremors, fast breathing, and vomiting are some symptoms of NAS.
  • Doctors use neonatal abstinence scoring systems to determine the severity of the condition.
  • Comforting the baby, keeping them in a calm environment, and adding extra calories to their food are some ways to treat the condition.


  1. Key findings: Public Health Reporting of NAS Offers Opportunities For Treatment And Prevention.,NAS%20for%20public%20health%20monitoring
  2. Neonatal Abstinence Syndrome.
  3. Neonatal Abstinence Syndrome (NAS).
  4. Neonatal Abstinence Syndrome.
  5. Neonatal Abstinence Syndrome.
  6. Neonatal Abstinence Syndrome (NAS).
  7. Neonatal Abstinence Syndrome.
  8. Testing And Diagnosis For Neonatal Abstinence Syndrome in Children.
  9. Cordelie E., Witt et al. Neonatal abstinence syndrome and early childhood morbidity and mortality in Washington state: a retrospective cohort study.
  10. Neonatal abstinence syndrome.
  11. Saminathan Anbalagan and Magda D. Mendez; (2022); Neonatal Abstinence Syndrome.
  12. Clonidine for Neonatal Abstinence Syndrome (NAS).
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Dr. Dur Afshar Agha is a consultant pediatrician with around 26 years of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association.

Read full bio of Dr. Dur Afshar Agha
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