What is Neonatal Abstinence Syndrome?
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Infant withdrawal or Neonatal Abstinence Syndrome (NAS) can occur when an infant has been exposed to opiates (including heroin, methadone and buprenorphine), stimulants, sedatives, alcohol and some antidepressants during pregnancy. It is not possible to reliably predict, before birth, which babies may develop NAS. The incidence of NAS is not directly related to the type or amount of substance used. NAS is readily diagnosed and treated.
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Most babies show some signs of NAS, but not all of these babies will require treatment with medication. Non-medication treatment involves the use of supportive therapy such as swaddling, cuddling and use of pacifiers in a quiet environment with reduced stimulation. Many babies benefit from receiving additional formula feeds during the first few days of establishing breastfeeding.
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Assessment
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Babies who have been exposed to narcotics, stimulants, sedatives, alcohol and some antidepressants in pregnancy are closely observed for signs of NAS. In Australia, a modified Finnegan scoring system is used to assess the level of withdrawal in newborn babies. Babies are assessed approximately every 4 hours (1/2-1 hour after each feed) according to signs relating to sleeping, feeding, skin colour, muscle tone and cry. Common signs of withdrawal include irritability, poor feeding, increased muscle tone and tremor.
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This assessment continues for up to 7 days following birth. If, after 7 days of assessment, your baby has not shown significant signs of NAS, and there are no other health issues, you and your baby will be discharged from hospital. You will be visited at home by the hospital domicilliary midwife and referred to your local Maternal and Child Health Nurse and GP for ongoing support and care.
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Treatment
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If your baby has shown significant signs of NAS during the 7 day assessment period, he/she will be transferred to a nursery for specialist care. There may be a further period of assessment prior to confirmation of NAS. If your baby requires treatment he/she will commence using a low dose of medication which is given orally. The dose is usually given every 6 hours with a reduction in dose every 3 days. During the treatment period, babies continue to be observed for signs of withdrawal. There may be variation in the treatment time according to your baby's progress. This gradual reduction of medication takes approximately 4 weeks. Occasionally more than one medication is required depending on the baby's withdrawal.
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You and your family will be encouraged to spend as much time as possible with your baby during the treatment period. Babies respond very well to the love that only parents can give. Some nurseries have a "Cuddler Program" using volunteers for the times when you cannot be present. The volunteers are specially trained to cuddle and comfort your baby under the supervision of nursery staff.
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Breastfeeding is of great benefit to your baby. Nursery staff will advise and assist you in breastfeeding your baby. You should not breastfeed your baby if you are using heroin or are HIV positive. If you are on any drugs besides methadone, this may affect the safety of breastfeeding your baby. In these circumstances, breastfeeding should be considered on a case-by case basis.
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Where to get more information
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Women’s Alcohol and Drug Service
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Cnr Grattan Street & Flemington Road
Parkville 3052
9.00am – 5.00pm Monday to Friday
Tel: (03) 8345 3931
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Email: wads@thewomens.org.au
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Web: http://www.thewomens.org.au/CareforWomenwithDrugAlcoholIssues
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Also see: Neonatal Abstinence Syndrome (NAS) - Infant withdrawal information for parents (pdf 152kb)
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Disclaimer
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The Royal Women’s Hospital does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided in this fact sheet or incorporated into it by reference. We provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.
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Last updated April 2008
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