1) Neonatal abstinence syndrome
If mothers are using opioids (legal and illegal) during pregnancy, their baby is exposed to the medication and becomes use to it.
After delivery, the baby no longer receives these medications and develops signs of withdrawal. This is called neonatal abstinence syndrome (NAS).
2) Signs of neonatal abstinence syndrome
Babies with NAS may:
- Show neurological abnormalities,including:
- A high-pitched cry.
- Generalized convulsions.
- Excessive sucking or rooting.
- Sleeping less.
- Having tense muscles.
- Have feeding and digestive problems,including:
- Poor feeding.
- Have a fever.
- Have several different shades of skin colour (mottled).
- Breathe too fast.
NAS develops in 50% to 75% of babies born to mothers who use opioids (Casper 2014). It can start between 1 and 10 days after delivery and last up to several months (Kocherlakota 2014). The timing and severity of NAS depend on:
- The type and amount of opioids
- The time of the mother’s last use of opioids.
- The number of opioids used.
- How long opioids were used during the pregnancy.
3) Effects of neonatal abstinence syndrome
Over the longer term, babies who have had NAS are at an increased risk of sudden infant death syndrome (SIDS) and abnormalities in brain development.
4) Caring for babies with neonatal abstinence syndrome
Traditionally, babies born with NAS were cared for in a hospital neonatal intensive care unit (NICU). These units are generally high-stress environments that may limit a mother’s access to her baby.
More recently, babies who are full term or near term and are medically stable are cared for by their mothers in hospital but outside of the NICU (Lacaze-Masmonteil 2018). The benefits of this include the following (MacMillan 2018; MacVicar 2019; Wachman 2018):
- Mothers and babies being in a less stressful environment
- Higher rates of mothers starting to breastfeed
- Babies spending more time skin-to-skin
- Babies needing less medication to treat NAS
- Babies requiring less time in hospital
- Lower treatment costs for healthcare systems
5) Breastfeeding babies with neonatal abstinence syndrome
Mothers need to ensure that they meet the criteria for safe breastfeeding before proceeding.
Breastfeeding babies with NAS (Favara 2019; Wu 2018):
- Reduces the amount of time they spend in hospital.
- Decreases the severity of NAS.
- Decreases the amount of medication they need.
These benefits may come from (Bogen 2019):
- The calming effect of breastfeeding.
- The qualities of breast milk.
- Healthier gut bacteria (microbiome).
- The small amounts of opoids in breast milk that may help the baby to withdraw.