MSN-Ed, BSN, RN
Opioid use in pregnancy is on the rise. From 2012 to 2017, the number of women in the U.S. with opioid-related diagnoses documented at delivery increased by 131%. As a result, neonatal abstinence syndrome (NAS) is more prevalent now that in years prior. From 2000 to 2012, the incidence of NAS increased 383%.
In recent years, evidence has shown a persistent incline in NAS. The CDC estimates that one baby is diagnosed with NAS every 24 minutes the U.S. NAS is a growing problem that needs special attention. Learn about this condition and how nurses can manage the care of the baby with this condition.
Neonatal Abstinence Syndrome (NAS) is a group of problems that can occur when a baby is exposed to opioids and other addictive drugs during utero. The drugs pass through the placenta and the baby becomes dependent along with the mother.
If the mother continues to use the drug within the first week before birth, the baby will be dependent upon birth. After birth, the baby can go through withdrawal symptoms – some of which are similar to those of an adult, like trembling and seizures.
Exposure to certain types of drugs during utero can cause withdrawal symptoms in the baby.
Drugs that can cause long-term problems for the baby include:
Fetal alcohol syndrome (FAS) is a combination of problems that can occur after a baby has been exposed to alcohol during utero. Problems may be developmental, physical, and mental.
Although similar, FAS is not NAS. FAS is a condition that is under the umbrella of NAS. Alcohol is considered a drug and therefore can cause withdrawal symptoms like opioids and other addictive drugs. However, FAS is a broader term that encompasses more than alcohol withdrawal symptoms.
FAS includes conditions that can occur over the lifespan of a baby. Many babies who were exposed to alcohol during utero experience problems associated with abnormal brain development well into adulthood.
NAS is the broader term to describe the problems associated with the withdrawal period, which is treatable. Some conditions that result from FAS can cause delayed developmental milestones and require long-term medical management.
Babies with NAS can be hard to calm as they are often fussy. Symptoms of NAS can start up to a week after birth but usually surface within the first one to three days.
Symptoms can vary based on if the baby was born full-term or preterm. In addition, the type of drug and length of use can cause variations in symptoms. NAS can cause complications that can be both short and long-term.
Symptoms of NAS can be confused with many other conditions. In order to properly diagnose NAS, a complete physical assessment of the baby and a detailed history from the mother is vital. The NAS scoring system is a tool that nurses can use to determine the severity of withdrawal symptoms which can assist with the treatment plan.
A final diagnosis can be made by evaluating a piece of the umbilical cord or performing a urine or meconium (stool) drug screen on the baby.
Depending on the severity of symptoms, babies with NAS may require treatment with medications that mimic the drug the mother used during pregnancy. This may include methadone and morphine.
The goal is to safely wean the baby off of the original drug while relieving withdrawal symptoms. Treatment for NAS can last up to six months.
The main goal of the nurse in the care of the baby with NAS is to ensure that the baby is comfortable and able to meet nutritional needs. This may be achieved by focusing on relief of withdrawal symptoms and providing adequate nutrition.
Establishing a comfortable environment by reducing noise may be helpful. Since babies with NAS are often fussy due to the symptom discomfort, nurses can swaddle and gently rock the baby. Nurses should also educate caregivers that the baby may need consistent tender care for months after discharge from the hospital.
In order to meet the nutritional needs of the baby, nurses are encouraged to provide small frequent high-caloric feedings.
Neonatal abstinence syndrome is a preventable condition that can cause significant discomfort and long-term complications in babies. Although a nurse may not give direct obstetric or neonatal care, any nurse can advocate for babies by providing general education to women of childbearing age who drink alcohol, smoke cigarettes, or use other drugs, especially if there is an intent to get pregnant.
By providing education and bringing awareness to NAS, nurses can help to keep babies safe and healthy for years to come.
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