Neonatal abstinence syndrome (NAS) is a diagnosis of postnatal opioid withdrawal in newborns, and it most often occurs when a mother takes opioids during her pregnancy. Opioids — whether prescription medications such as pain pills or street drugs such as heroin — can pass through the placenta during pregnancy and cause serious health consequences for the baby at birth.
A recent review published in The New England Journal of Medicine looked at the increase in the rates of NAS in the U.S. and discussed the healthcare implications.
During the years 2009-2012, there were 21,732 diagnosed in the United States, and this represented an increase of five times during the previous years of 2000-2009. The cost of the care-related NAS births went from $732 million to $1.5 billion with 81 percent of the cost being borne by Medicaid programs.
The symptoms begin as early as one day after birth, but may take up to a week to manifest themselves. The symptoms can include:
- Blotchy skin coloring (mottling)
- Diarrhea
- Excessive crying or high-pitched crying
- Excessive sucking
- Fever
- Hyperactive reflexes
- Increased muscle tone
- Irritability
- Poor feeding
- Rapid breathing
- Seizures
- Sleep problems
- Slow weight gain
- Stuffy nose, sneezing
- Sweating
- Trembling (tremors)
- Vomiting
Addiction to opioids during a pregnancy and the treatments make the balance of maternal and fetal health difficult. Treatment of the maternal addiction with opiate maintenance using buprenorphine during pregnancy has serious neruobehavioural developmental consequences for the developing fetus.
A 2013 study evaluated 25 such exposed children between the ages of 5 and 6 years. They had serious visual and motor deficits as well as memory dysfunction.
While little is known about the long-term consequences of the NAS opioid-exposed babies, a recent study undertaken in New South Wales and Australia compared a group of 2,234 children that had the diagnosis of NAS to those in a group of 598,265 who were matched for gestation, socioeconomic status and gender.
Researchers found the results for a National Assessment Program on Literacy and Numeracy that was given in grades 3, 5 and 7. The test scores were significantly lower for NAS children in grade 3, and the deficits were progressive. By grade 7, the children with NAS were scoring lower than the control group in grade 5.
"Early intervention and support for both the mothers and their children have been shown to be extremely effective in high-risk populations, and the benefits can extend for decades and even into generations," reported one of the researchers, Lee Oei, M.D., a neonatologist at the Royal Hospital for Women in New South Wales.
The Massachusetts Department of Children and Families has estimated that professionals in their state are devoting 10,000 hours each month to the care of NAS infants. There will continue to be need for investment in social services, foster care, early intervention programs and other family services.
