Neonatal abstinence syndrome (NAS) occurs when newborn infants experience withdrawal symptoms after birth due to being exposed to drugs like opioids, benzodiazepines, or alcohol in the womb. Symptoms of NAS vary based on the type and amount of drug used but often begin within a week of birth. Diagnosis involves screening the mother's drug use and testing the newborn. Treatment may involve non-pharmacological comfort measures for mild cases or medications to relieve withdrawal for more severe cases. Babies with NAS often need to stay in the hospital for monitoring and treatment for up to 6 months. Preventing NAS requires mothers abstaining from substance use during pregnancy.

1. NOEL CHRISTIAN
GROUP : 6

2. 

3. 
Neonatal Abstinence Syndrome
 Neonatal withdrawal or Neonatal Abstinence Syndrome (NAS) is a withdrawal
syndrome of infants after birth caused by in utero exposure to licit or illicit
drugs, especially opiates.
 There are two types of NAS:
* Prenatal
* Postnatal
 Prenatal NAS is caused by discontinuation of drugs taken by the pregnant
mother, while postnatal NAS is caused by discontinuation of drugs directly to
the infant.

4. 
Causes
 Neonatal abstinence syndrome may occur when a pregnant woman takes
drugs such as heroin, codeine, oxycodone (Oxycontin), methadone or
buprenorphine.
 These and other substances pass through the placenta that connects the baby
to its mother in the womb. The baby becomes dependent on the drug along
with the mother.
 Because the baby is no longer getting the drug after birth, withdrawal
symptoms may occur as the drug is slowly cleared from the baby's system.

5. 

6. 
 Withdrawal symptoms also may occur in babies exposed to alcohol,
benzodiazepines, barbiturates, and certain antidepressants (SSRIs)
while in the womb .
 Babies of mothers who use other addictive drugs (nicotine,
amphetamines, cocaine, marijuana) may have long-term problems.

7. 
Symptoms
 The symptoms of neonatal abstinence syndrome depend on:
* The type of drug the mother used
* How the body breaks down and clears the drug
* How much of the drug she was taking
* How long she used the drug
* Whether the baby was born full-term or premature
 Symptoms often begin within 1 to 3 days after birth, but may take up to a week to
appear. Because of this, the baby will most often need to stay in the hospital for
observation and monitoring for up to a week.

8. 

10. 
Exams & Tests
 Many other conditions can produce the same symptoms as NAS.
 To help make a diagnosis, the health care provider will ask questions about the
mother's drug use.
* The mother may be asked about which drugs she took during
pregnancy, and when she last took them.
* The mother's urine may be screened for drugs as well.

11.  Tests that may be done to help diagnose withdrawal in a newborn include:
 CBC, hair analysis, drug screen (of mother and infant), thyroid levels,
electrolytes, and blood glucose. Chest x-rays can confirm or infirm the
presence of heart defects.
 Neonatal abstinence syndrome scoring system, which assigns points based on
each symptom and its severity. The infant's score can help determine
treatment.
 Toxicology (drug) screen of urine and of first bowel movements (meconium).

12. 

13. 

14. 
Treatment
 Treatment depends on:
* The drug involved
* The infant's overall health and abstinence scores
* Whether the baby was born full-term or premature
 The health care team will watch the newborn carefully for up to a week after
birth for signs of withdrawal, feeding problems, and weight gain. Babies who
vomit or who are very dehydrated may need to get fluids through a vein (IV).

15.  Infants with neonatal abstinence syndrome are often fussy and hard to calm. Tips
to calm the infant down include measures referred to as "TLC" (tender loving care):
* Gently rocking the child.
* Reducing noise and lights.
* Swaddling the baby in a blanket.
 Some babies with severe symptoms need medicines such as methadone and
morphine to treat withdrawal symptoms.
 The goal of treatment is to prescribe the infant a drug similar to the one the mother
used during pregnancy and slowly decrease the dose over time. This helps wean
the baby off the drug and relieves some withdrawal symptoms.

16.  If the symptoms are severe, a second medicine such as phenobarbital or
clonidine may be added.
 Babies with this condition often have severe diaper rash or other areas of skin
breakdown. This requires treatment with special ointment or cream.
 Babies may also have problems with feeding or slow growth. These problems
may require:
* Higher-calorie feedings that provide greater nutrition
* Smaller portions given more often

17. 
Prognosis
 Treatment helps relieve symptoms of withdrawal. Even after medical
treatment for NAS is over and babies leave the hospital, they may need
extra "TLC" for weeks or months.

18. 
Possible Complications
 Drug and alcohol use during pregnancy can lead to many problems.
These may include:
* Birth defects
* Low birth weight
* Premature birth
* Small head circumference
* Sudden Infant Death Syndrome (SIDS)
* Problems with development and behavior
 Neonatal abstinence syndrome treatment can last from 1 week to 6 months. Even
after medical treatment for NAS is over and babies leave the hospital, they may
need extra "TLC" for weeks or months.

19. 
Preventions
 Neonatal withdrawal is prevented by the mother abstaining from substance
abuse. Prescribed medication may have to be discontinued during the
pregnancy to prevent addiction by the baby.
 Women can discuss all medicines, and alcohol and tobacco use with their
health care provider and get assistance to help stop drug use as soon as
possible. Indications that a woman needs help if she is:
* Using drugs non-medically
* Using drugs not prescribed to you
* Using alcohol or tobacco

20. 
References
 Bencke M, Smith VC, Committee on Substance Abuse, Committee on Fetus and
Newborn. American Academy of Pediatrics. Prenatal substance abuse: short- and
long-term effects on the exposed fetus (technical report). Pediatrics.
2013;131(3):e1009-24. PMID: 23439891 www.ncbi.nlm.nih.gov/pubmed/23439891.
 Hudak ML, Tan RC, Committee on Drugs, Committee on Fetus and Newborn: American
Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics. 2012;129(2):e540-
60. PMID: 22291123 www.ncbi.nlm.nih.gov/pubmed/22291123.
 Lawn C, Aiton N. The baby of a substance-abusing mother. In: Rennie JM, ed. Rennie
and Roberton's Textbook of Neonatology. 5th ed. London, UK: Elsevier Churchill
Livingstone; 2012:chap 26.
 Patrick SW, et al. Prescription opioid epidemic and infant outcomes. Pediatrics.
2015;135:842-850.

21. 