Makindo Medical Notes

Neonatal Abstinence Syndrome (NAS): Some neonates may be experiencing withdrawal symptoms from opioids, benzodiazepines, nicotine, and/or alcohol exposure.

About

• NAS refers to drug withdrawal symptoms in neonates, typically following chronic opioid exposure in utero.
• Efforts to reduce maternal drug use during pregnancy are crucial for prevention.
• Consider screening for concurrent conditions like HIV, Hepatitis B, and C due to potential maternal drug use.
• The term "Neonatal Opioid Withdrawal Syndrome" (NOWS) is also used for opioid-specific cases.

Common Drugs Associated with NAS

• Methadone and other opioids
• Heroin, Benzodiazepines
• Cocaine, Amphetamines
• Caffeine, Nicotine, Antidepressants

Clinical Features

• Irritability, high-pitched cry, and tremors
• Seizures, yawning, fever, and tachypnoea
• Poor feeding, vomiting, and hypoglycaemia

Investigations

• Urine toxicology screening for presence of substances.
• Consider testing for HIV, Hepatitis B, and C in high-risk cases.

Scoring System

Modified Lipsitz Score Tool – A tool for assessing NAS severity.

Signs	0	1	2	3
Tremors (muscle activity of limbs)	Normal	Minimally increased when hungry or disturbed	Moderate or marked increase when undisturbed; subsides when fed or held snugly	Marked increase or continuous even when undisturbed, progressing to seizure-like movements
Irritability (excessive crying)	None	Slightly increased	Moderate to severe when disturbed or hungry	Marked even when undisturbed
Reflexes	Normal	Increased	Markedly increased	-
Stools	Normal	Explosive, but normal frequency	Explosive, more than 8 per day	-
Muscle tone	Normal	Increased	Rigidity	-
Skin abrasions	No	Redness of knees and elbows	Breaking of skin	-
Respiratory rate / minute	< 55	55-75	76-95	-
Repetitive sneezing	No	Yes	-	-
Repetitive yawning	No	Yes	-	-
Vomiting	No	Yes	-	-
Fever	No	Yes	-	-

Management of the Neonate

• Provide a specialized care setting with rooming-in, breastfeeding support, gentle handling, and swaddling.
• Dark, quiet environments are essential for non-pharmacologic treatment.
• Monitor infants with the NAS chart over several days to assess symptom progression and need for intervention.
• Small doses of morphine may be administered to alleviate symptoms, with a gradual weaning process.
• In some cases, phenobarbital may be used as an adjunct treatment.
• Ensure testing for Hepatitis C in mothers with a history of intravenous drug use.
• Prior to discharge, coordinate with social services for ongoing support, and assign a named social worker for follow-up care.

References

• Neonatal Abstinence Syndrome (NAS) - NASADAD Fact Sheet