Neonatal abstinence syndrome is a growing problem in Tennessee. NAS happens when babies are in contact with medications or illegal drugs in the womb. These babies form a physical dependence on the drug used by their mother during pregnancy. After birth, they experience withdrawal just like adults. Withdrawal symptoms vary, but can include high-pitched crying, tremors, hyperactive reflexes and inconsolability. In some cases, drug dependent babies suffer seizures as well.

1. EAST TENNESSEE CHILDREN’S HOSPITAL
WWW.ETCH.COM
Form No. 31067 (02/15)
Neonatal Abstinence Syndrome (NAS)
Neonatal abstinence syndrome is a growing problem in Tennessee. NAS happens when babies are in contact with
medications or illegal drugs in the womb. These babies form a physical dependence on the drug used by their mother
during pregnancy. After birth, they experience withdrawal just like adults. Withdrawal symptoms vary, but can include
high-pitched crying, tremors, hyperactive reflexes and inconsolability. In some cases, drug dependent babies suffer
seizures as well.
In 2014, 265 of 761 babies admitted to the Children’s Hospital
Neonatal Intensive Care Unit (NICU) were suffering from NAS. The
neonatal team also helps care for drug dependent newborns
at Fort Sanders Regional Medical Center and Parkwest Medical
Center whose symptoms were not severe enough to warrant NICU
admission.
The most common form of drug dependence seen in the Children’s
Hospital NICU is opioids, a class of drugs commonly prescribed
for pain management and addiction recovery. Babies become
dependent on opioids and other drugs their mothers use during
pregnancy because the drugs cross the placenta, and pass from
mother to baby. When infants are born with drug dependence, they are at a higher risk for heart, spinal, and intestinal
defects, as well as learning and behavioral problems as they reach school age.
Faced with the growing problem, the Children’s Hospital NICU staff came together
to create a better protocol for treating babies suffering from NAS. The NICU staff
implemented a new, multifaceted treatment protocol that involves several disciplines
throughout the hospital. Physicians, neonatal nurse practitioners, bedside nurses,
social workers, a case manager, the rehabilitation team, and a pharmacist joined
together to develop this approach that involves evaluating neonates with NAS
by using the Finnegan Scoring System (which analyzes a range of central nervous
system, metabolic, gastrointestinal and respiratory symptoms). The resulting score
allows the NICU staff to adjust treatment as needed.
The next important step is to get the initial symptoms of withdrawal under control
without medication. Children’s Hospital accomplishes this by keeping babies
swaddled in private rooms. The rooms are kept quiet and dark, avoiding over
stimulation. A specialized diet, baby swings, and a group of trained volunteer
cuddlers are also key to soothing babies with NAS.
If withdrawal symptoms are severe enough, doctors and nurses will administer small
amounts of oral morphine dosages based on the severity of the symptoms. The
final goal of the protocol is weaning the baby off the medication as he becomes less
dependent on a drug.
Addiction Vs.
Drug Dependence
Drug Addiction: a
behavior of compulsive
drug use despite
harmful consequences;
characterized by an
inability to stop using a
drug.
Drug Dependence: a
physical dependence
on a drug, which can
happen with chronic use
of many drugs, including
prescription drugs taken
as instructed. Physical
dependence on a drug
does not constitute
addiction.
NAS babies are
dependent, not addicted.