Tolerance, dependence, and withdrawal may occur as a result of repeated administration of drugs, or after short-term high-dose use—for example, during mechanical ventilation in intensive care units.
A baby born at full-term may commonly exhibit symptoms such as mottling (net-like bluish-red skin due to swollen blood vessels),[6] irritability, trembling, excessive or high-pitched crying, sleeping problems, increased muscle tone, overactive reflexes, seizures, yawning, stuffy nose, sneezing, poor feeding, rapid breathing, slow weight gain, vomiting, diarrhea, sweating, fever or unstable temperature.
Untreated NAS symptoms can cause developmental issues such as altered cognitive, social, emotional, and behavioral capacities that appear later in life.
[7] Long term effects vary by the substance that the neonate gets exposed to but they most commonly have been shown to affect growth, behavior, cognitive function, vision problems, motor problems, language, academic achievement, otitis media (infection or inflammation of the middel ear), and predisposition to self utilization of drugs.
Opioid exposure has shown visual impairments such as reduced ability to see fine detail and uncontrolled eye movements.
[10][11] Some common drugs that could result in NAS withdrawal or withdrawal-like symptoms in neonates are opioids; agonists such as morphine, codeine, methadone, meperidine, oxycodone, propoxyphene, hydromorphone, hydrocodone, fentanyl, tramadol, and heroin, antagonists such as naloxone, and naltrexone, and mixed agonist-antagonists like pentazocine and buprenorphine.
CNS depressants; alcohol, barbiturates, benzodiazepines, other sedative hypnotics, methaqualone, glutethimide, chloral, hydrate, cannabinoids, marijuana, and hashish.
This can include low birth weight, reduced head circumference, cognitive deficits, emotional dysregulation, high impulsiveness, and higher risk to develop a substance disorder.
Compared to the control group, the cocaine-exposed infants share a few features which includes jittery, tremors, irritable, excessive suck, extreme alertness, abnormal breathing and autonomic instability.
Based on how much of the drug the infant was exposed to, there is a positive dose-response relationship between exposure of cocaine and hyperactivity along with the adaptability to its environment.
[18] With long term exposure of alcohol from the pregnant individual to newborn infant, there are withdrawal symptoms from the central nervous system depressant.
These traits were characterized by tremors, hypertonia, restlessness, excessive mouthing movements, inconsolable crying and reflex abnormalities.
[21] Some non-genetic risk factors include smoking and methadone use of the birthing person during pregnancy that can result in increased severity of NAS.
[29] The scoring system assesses the neonate and observes the severity of the following characteristics: crying; sleeping; moro reflex; tremor; increased muscle tone; excoriations of chin, knees, elbows, toes, and/or nose; myoclonic jerks; generalized convulsions; sweating; hypothermia; and many others.
[34] Traditionally, if an infant has been diagnosed with NAS after proper monitoring, then management of the disease is often handled in the Neonatal Intensive Care Unit (NICU).
As per the AAP 2020 Guidelines, it is no longer recommended to admit infants to the NICU if they only have NAS since this can cause more problems that can aggravate symptoms due to the loud and overly stimulating environment as well as create a traumatic experience for the birthing parent.
[29] According to the ACOG 2017 Guidelines, it is recommended that if the birthing parent has a history of opioid use during pregnancy, then the infant must be monitored by a pediatrician for the possibility of NAS.
[29] Non-medication based approaches to treat neonatal symptoms include swaddling the infant in a blanket, minimizing environmental stimuli, and monitoring sleeping and feeding patterns.
[37] Nonpharmacological interventions are usually prioritized for the treatment of infants with NAS, but for those experiencing severe opioid withdrawal then the use of medications is to be considered.
[29] Medications are used to minimize clinical signs of withdrawal including fever, seizures, and weight loss or dehydration.
[29][38][39] According to the AAP 2020 Guidelines, it is recommended to use opioids with a longer half-life like buprenorphine and methadone, but it is important to take caution if the preparation has a high alcohol content.
When compared to morphine, methadone has a longer half-life in children, which allows for less frequent dosing intervals and steady serum concentrations to prevent neonatal withdrawal symptoms.
[45] A 2017 Centers for Disease Control (CDC) report stated that the number of babies born with NAS increased nationally by 82% from 2010 to 2017.
[29] In 2024, a study evaluated the early results of the 2020 American Academy of Pediatrics guidelines for managing neonatal opioid withdrawal symptoms.
[52] The dramatic growth in numbers of neonates born with drug addiction will continue to grow if not confronted and managed in a way that is specific and appropriate for the city of North Bay.