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Neonatal Abstinence Syndrome: Recognizing the Signs

The opioid epidemic has been a growing public health concern in the US. Unfortunately, the problem extends beyond people directly suffering from substance abuse issues. Neonatal Abstinence Syndrome, also called NAS, is a growing public health concern. Neonatal Abstinence Syndrome is rapidly becoming a leading cause of developmental and medical issues in newborns that can have long-term negative impacts on health.

Nurses, especially those who frequently work with pregnant people and newborns, must ensure they are well-equipped to identify this condition. Pursuing nursing continuing education courses on NAS can prepare you to understand how you can play a vital role in ensuring a positive outcome for newborns suffering from the condition.

The first step in delivering timely intervention to protect newborns from the long-term effects of neonatal abstinence syndrome is understanding how to recognize the signs. Today’s post will give you a quick overview of what NAS is and the signs you must know as a nurse.

What is Neonatal Abstinence Syndrome?

Neonatal abstinence syndrome is a diagnosis given to babies suffering from withdrawal symptoms after birth. It occurs when the newborn is exposed to an addictive substance in the womb and is essentially abstaining from it because they no longer have exposure to it after birth. The condition results in several symptoms in newborns, including tremors, convulsions, fever, and several others. It is an increasingly growing public health concern, with as many as 80 newborns being diagnosed with the condition each day.

NAS occurs most often when the pregnant person carrying the baby takes opioids during the pregnancy. However, it can also be caused by taking antidepressants and sleeping pills. When pregnant women take these drugs with addictive properties during pregnancy, they can pass through the placenta and into the fetus, essentially making them addicted to the drugs before birth.

What are the Signs of Neonatal Abstinence Syndrome?

NAS results in newborns showing signs of withdrawal caused by abstaining from the addictive substance they were exposed to. Symptoms of the condition typically appear one to five days after birth, depending on the specific substance and when the newborn was last exposed to it. As a nurse, it is important to understand what you need to look for to identify newborns suffering from NAS.

Neonatal Abstinence Syndrome results in a cluster of symptoms comprising of three categories:

  • Neurological symptoms
  • Gastrointestinal symptoms
  • Autonomic symptoms

Neurological Symptoms of NAS

The most apparent symptoms of the condition are neurological. A newborn experiencing withdrawal may show tremors in their arms or legs. Irritability is another neurological symptom, where the newborn cries excessively for long periods of time. Newborns typically sleep for most of the day, but newborns suffering from NAS may remain awake for longer periods.

Babies with NAS may also show subtle signs like unusually frequent sneezing and yawning. One of the most severe neurological symptoms of NAS is the sudden onset of seizures. As a nurse, you must be vigilant of these signs to identify NAS and be astute for potential seizure activity.

Gastrointestinal Symptoms of NAS

Gastrointestinal dysfunction is another group of symptoms babies with NAS may show, including:

  • Poor feeding: Babies with NAS may not be consuming enough breast milk to maintain healthy weight gain. Constant, uncoordinated, or excessive sucking might also be a sign indicating NAS.
  • The baby might suffer from vomiting and diarrhea.
  • Dehydration can occur, resulting from poor feeding, diarrhea, and vomiting.

Gastrointestinal dysfunction symptoms are not as easy to use for diagnosing NAS, especially in the first few days post birth. Some babies may just be learning to eat or not need large volumes of milk during the first few days after birth.

Autonomic Symptoms of NAS

The third category of the cluster of symptoms that babies with NAS show are autonomic nervous system symptoms, including:

  • Nasal stuffiness is a symptom where the baby may have congestion.
  • Increased sweating, especially when the baby is more irritable, is another sign of NAS.
  • Fever may be another sign of NAS in newborns, but it is important to rule out infection before associating it with NAS alone.
  • Irregular body temperature changes are also another sign that a baby might have NAS.
  • Faster breathing, or tachypnea, is another symptom babies with NAS might show.

What Complications can Neonatal Abstinence Syndrome Cause?

Babies with NAS might develop health conditions that require treatment in the hospital’s neonatal intensive care unit (NICU) after birth. Aside from withdrawal symptoms, newborns with NAS may be at a greater risk of developing several issues, including:

  • Jaundice: This is when a baby’s skin and eyes have yellow coloration caused by the liver not being fully developed or an improperly functioning liver.
  • Low birth weight: Babies weighing less than 5lbs and 8oz.
  • Sudden Infant Death Syndrome: SIDS is the inexplicable death of a baby younger than 12 months, typically occurring when a baby is asleep.
  • Seizures

Is Neonatal Abstinence Syndrome Treatable?

It is possible to help babies with NAS recover from the condition. Most babies with NAS can begin getting better in 5-30 days, provided the condition is diagnosed and treated on time. The treatment for babies with NAS can vary, depending on several factors. However, the treatment may include:

  • Administering medicine to manage severe withdrawal symptoms. Once the withdrawal symptoms are under control, the baby may be given smaller doses of the medicine to help them wean off it.
  • Babies with NAS, especially those unable to feed properly, may need to be provided fluids through IVs to prevent them from getting dehydrated.
  • Babies with NAS may be given higher-calorie baby formula due to trouble with feeding or slow growth.

Are You Prepared to Identify the Signs of Neonatal Abstinence Syndrome?

If you are a nurse who works closely with pregnant mothers and newborns, you must understand how to identify the signs of NAS. Timely diagnosis of NAS and delivering appropriate treatment can be critical in saving babies lives.

Pursuing nursing continuing education courses that help you identify the signs of Neonatal Abstinence Syndrome can help you better understand the signs in a timely manner and provide the necessary medical intervention to treat newborns with NAS. Online CEUs like the ones available at Fast CE For Less at https://fastceforless.com/ce-courses-for-nursing/ can be critical in helping you deliver the best care in such situations.


  1. https://www.cdc.gov/pregnancy/opioids/data.html#:~:text=That%20is%20approximately%20one%20baby%20diagnosed%20with%20NAS%20every%2019%20minutes%20in%20the%20United%20States%2C%20or%20nearly%2080%20newborns%20diagnosed%20every%20day

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