What is Neonatal abstinence syndrome

Neonatal abstinence syndrome is a collection of problems a baby experiences when withdrawing from drugs use (by the mother during pregnancy). Because of this, it is also known as infant narcotic withdrawal. A syndrome is a collection of signs and symptoms, grouped together and recognised as a manifestation of a certain disease.
Almost every drug that the mother takes during pregnancy passes from the mother’s blood to the foetus (foetus means unborn baby). If the mother has been taking illicit substances such as narcotics, the foetus can get addicted with these substances. After birth, the baby’s dependence on the substance will remain, but there will be no more drugs available. Hence the baby’s central nervous system will be stimulated, leading to the symptoms of withdrawal.
Many drugs are associated with neonatal abstinence syndrome. These include opiates, cocaine, amphetamine, alcohol and many more.

Statistics on Neonatal abstinence syndrome

The cases of neonatal abstinence syndrome is directly related to the percentage of illicit drug use of the population. Based on the Australian National Drug Strategy Household Survey, nearly 50% of the people reported to have used an illicit drug in their lifetime.
The cases of neonatal abstinence syndrome is on the rise in Australia. This is directly due to the increase of illicit drug use in the population in Australia.

Risk Factors for Neonatal abstinence syndrome

Several drugs are strong risk factors of a baby developing neonatal withdrawal symptoms when compared to other drugs. The following drugs place the newborn at a higher risk of this disease:

  • opiates
  • cocaine and derivatives
  • amphetamines (speed)
  • alcohol


Progression of Neonatal abstinence syndrome

Neonatal abstinence syndrome is in general harmless in the long term. However the risk of sudden infant death syndrome (SIDS) is significantly higher in newborn babies. SIDS is a clinical entity where the baby within 1 year old suddenly dies without any causes to
be found.
Aside from complications occurring after birth, some can happen before birth. This include the following:

  • low birth weight
  • premature birth
  • bleeding in the brain
  • mental retardation
  • developmental delay
  • intellectual disability
  • birth defect


How is Neonatal abstinence syndrome Diagnosed?

Diagnosis of neonatal abstinence syndrome is by clinical means, using the modified Finnegan Scoring System. (see clinical examination)

Prognosis of Neonatal abstinence syndrome

Neonatal abstinence syndrome responds very well to drug therapy and hence has a very good prognosis. They tend to be responding well to morphine or phenobarbitone (see treatment overview). The disease itself tends to resolve over time. However if any complications related to illicit drug use occur, the prognosis might change dramatically depending on the complications.

How is Neonatal abstinence syndrome Treated?

Although this disease affects the newborn baby, the mother should be included in the treatment as well. For the mother, current treatment of choice would be
using methadone (an opiate) if she needs pharmacological intervention. Methadone is safe for breastfeeding although there will be a small amount being transferred through to the breast milk.
Not all babies that are affected will need drug treatment as below. Those who are not having severe symptoms do not need any drug treatment. Non-drug treatment can be used to calm the baby down and reduce irritability – this include supportive therapy such as cuddling, swaddling, increase the number of feeds, use of pacifiers in a quiet and familiar environment for the babies. There has been evidence showing that music therapy works for neonatal abstinence syndrome as well.
As far as drug treatment for the baby is concerned, morphine is used in the management of neonatal abstinence sydnrome. Sometimes another drug called phenobarbitone is used as well.
Apart from these, other management options that should be considered include social service, mental health services and appropriate counselling.

Neonatal abstinence syndrome References

[1] 1998 National Drug Strategy Household Survey: Detailed findings [online]. 2000. [Cited 2005 September 21st]. Available from: URL:
[2] eMedicine: Neonatal Abstinence Syndrome [online]. 2004. [Cited 2005 September 21st]. Available from: URL: http://www.emedicine.com/ped/topic2760.htm
[3] Kelly JJ, Davis PG, Henschke PN. The Drug Epidemic: Effects on newborn infants and health resource consumption at a tertiary perinatal centre. J Paed Child Health. 2000;36(3):262-4.
[4] NSW Neonatal Abstinence Sydnrome Guidelines [online]. 2002. [Cited 2005 September 21st]. Available from: URL: