Neonatal Abstinence Syndrome (NAS)/Neonatal Opioid Withdrawal Syndrome (NOWS)
Neonatal Abstinence Syndrome (NAS) refers specifically to neonatal withdrawal from opioids. Common opioids that can lead to NAS include short acting opioids including hydromorphone, oxymorphone, morphine, oxycodone, codeine and heroin, and long acting opioids including methadone and buprenorphine. NAS describes a constellation of symptoms including CNS irritability, autonomic instability, and GI dysfunction. NAS occurs in 55-94% of infants exposed to opiates and varies in severity from mild to life-threatening. Clinical signs and symptoms of NAS depend on multiple factors including the type of opioid the infant was exposed to, timing of exposure before delivery, maternal health, and maternal and infant metabolism.
IHS NAS Guidelines
- NAS Guidelines Recommendation [PDF - 565 KB]
Incidence and costs of NAS are rising. NAS is a withdrawal syndrome in infants born to mothers who used opioids during pregnancy. Prevention and treatment of substance use disorders are imperative for women before, during and after pregnancy. See more in a nas infographic [PDF - 1.1 MB] by Vanderbilt University's Department of Pediatrics.
Breastfeeding and Illicit Drug Use - Indian Health Service Best Practice GuidelinesThe Indian Health Service recommends and supports breastfeeding as the normal method of infant feeding, in alignment with their adherence to the World Health Organization's Baby-Friendly Hospital Initiative. Formula feeding is associated with short and long term health risks. However, specific drugs can also potentially cause harm to infants when used by breastfeeding mothers. This document offers guidance on breastfeeding where illicit substances are of concern. Decisions should be made on a case by case basis by the clinicians, in consultation with the new mother.
- American Academy of Pediatrics Clinical Report: Neonatal Drug Withdrawal
- The American College of Obstetricians and Gynecologists Opioid Abuse, Dependence, and Addiction in Pregnancy
- Opioid Exposed Newborn: Assessment and Pharmacological Management (Journal of Opioid Management)
- Finnegan's Neonatal Abstinence Syndrome Scoring form
- Academy of Breastfeeding Medicine Guidelines for Breastfeeding and Substance Use or Use Disorder [PDF - 101 KB]
- Indian Health Service Neonatal Opioid Withdrawal Syndrome Pamphlet [PDF - 1 MB]
Note: Contact CDR Ted Hall at Ted.Hall@ihs.gov or 608-355-1240 extension 5582 to obtain a Microsoft publisher modifiable version for adaptation to your Tribal Health program.
- NAS Nursing Staff Education [PDF - 734 KB]
- Food and Drug Administration Advisory Committee: Neonatal Opioid Withdrawal Syndrome [PDF - 2.8 MB]