🍼 Neonatal Abstinence Syndrome (NAS) occurs when neonates experience withdrawal after exposure to opioids, benzodiazepines, nicotine, alcohol, or other drugs in utero.
It is a growing issue in neonatal units worldwide and requires both medical and social care coordination.
📖 About
- NAS = withdrawal symptoms in neonates, most often after chronic maternal opioid use.
- Also called Neonatal Opioid Withdrawal Syndrome (NOWS) when opioid-specific.
- Important to consider screening for HIV, Hepatitis B, and C in at-risk mothers.
- Prevention starts with maternal drug reduction programmes during pregnancy.
💊 Common Drugs Associated with NAS
- Opioids: Methadone, heroin, buprenorphine
- Benzodiazepines
- Cocaine, Amphetamines
- Nicotine, Caffeine
- SSRIs / Antidepressants
- Alcohol (may lead to fetal alcohol spectrum disorders as well as withdrawal)
🩺 Clinical Features
- Irritability & high-pitched cry 😢
- Tremors, seizures, yawning, sneezing
- Poor feeding, vomiting, diarrhoea 💩
- Fever, tachypnoea, sweating
- Hypoglycaemia in some cases
🔬 Investigations
- Urine or meconium toxicology screen for substances.
- Consider HIV, Hep B, and Hep C testing (depending on maternal risk).
- Blood glucose monitoring (risk of hypoglycaemia).
📊 Scoring – Modified Lipsitz Score Tool
This tool grades the severity of NAS and guides management. Scores are assessed regularly (every 2–4 hrs) to decide if pharmacological treatment is needed.
| Feature |
0 |
1 |
2 |
3 |
| Tremors |
Normal |
Mild ↑ when hungry/disturbed |
Moderate/marked when undisturbed, settles when held |
Marked continuous tremors or seizure-like |
| Irritability |
None |
Mild |
Moderate when disturbed |
Marked, even when undisturbed |
| Reflexes |
Normal |
Increased |
Markedly ↑ |
- |
| Stools |
Normal |
Explosive, normal freq. |
Explosive, >8/day |
- |
| Muscle tone |
Normal |
Increased |
Rigid |
- |
| Skin |
Normal |
Redness (knees/elbows) |
Skin breakdown |
- |
| Respiratory rate |
<55 |
55–75 |
76–95 |
- |
| Sneezing / Yawning |
No |
Repetitive |
- |
- |
| Vomiting |
No |
Yes |
- |
- |
| Fever |
No |
Yes |
- |
- |
🛠️ Management of the Neonate
- 👩👩👦 Environment: Quiet, dark room, swaddling, gentle handling, and rooming-in with mother where possible.
- 🍼 Feeding: Encourage breastfeeding if safe (except with maternal HIV in high-income countries).
- 📊 Monitoring: Use the NAS/Lipsitz score chart over several days.
- 💊 Pharmacological:
- Small doses of oral morphine for moderate–severe NAS, slowly weaned.
- Phenobarbital if refractory or polysubstance exposure.
- 🧾 Safeguarding: Ensure Hepatitis C testing if maternal IV drug use; involve social services, assign a named social worker before discharge.
🌍 References
