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What Is Neonatal Opioid Withdrawal Syndrome?
The Neonatal Opioid Withdrawal Syndrome is a medical condition that arises when a newborn is exposed to opioids via maternal blood circulation while still inside the uterus. Opioids enter the baby's body during the entire pregnancy period.
Once the baby is born and that exposure ends, the body must learn to function without those substances, and this adjustment period is what causes withdrawal symptoms.
NOWS can occur whether the opioid exposure was from prescribed medications, such as those used to treat opioid dependence during pregnancy, or from other sources. It is important to approach this topic without judgment. Many mothers on opioid treatment programmes are doing exactly what their doctors have recommended to protect their own health and their babies.
What Causes Neonatal Opioid Withdrawal Syndrome?
The development of NOWS is associated with a history of repeated exposure to opioids by the fetus before birth. These exposures may be due to:
- Prescription Opioids: These drugs include medications prescribed for pain relief in pregnant women.
- Opioid Replacement Therapy: Drugs such as Methadone or Buprenorphine are administered to manage opioid addiction.
- Opioids: Other forms of opioid drugs whose exposure to the fetus through the placenta may lead to the development of NOWS.
It is important to note that opioid replacement therapy is the safest and most medically advised method for women addicted to opioids. This is because the condition may develop in these instances.
How Does Neonatal Opioid Withdrawal Syndrome Affect the Baby?
Once the supply of opioids is cut off from the body, the nervous system responds with withdrawal symptoms. Symptoms depend upon the kind of opioids consumed, dosage, and duration of exposure.
Common Symptoms in the Baby
- Increased Crying
- Tremors or Shaking
- Difficulties with Feeding: Sleep Disruption
- Unusual Sweating
- Increased Breathing Rate
- Diarrhoea or Vomiting
Symptom Onset Time
The timing for symptom onset depends on the opioid type used:
- Short Acting Opioids: Within 24 to 48 hours post-birth.
- Long Acting Opioids such as Methadone: Within 48 to 72 hours post-birth.
How Do You Diagnose Neonatal Opioid Withdrawal Syndrome?
There is no single test for NOWS. The diagnosis involves a clinical evaluation using an appropriate scoring system. The Finnegan neonatal abstinence scoring system is the most widely used scoring system to assist clinicians in evaluating the severity of symptoms in infants.
Your baby will be observed from time to time, usually after a few hours, and their score will be considered by the care team to determine if further intervention is necessary.
This process guarantees that any variations in the well-being of your child will be detected early on and dealt with immediately.
Which Factors Determine the Level of Severe NowS Symptoms?
One should realise that exposure of infants to opioid use during pregnancy does not affect them equally. There are factors which may define the severity level of the withdrawal syndrome in infants, and these include:
- Opioid Type: There is a variety of opioids, but some may have a different half-life and transfer through the placenta.
- Length of Prenatal Exposure: The longer the time the fetus was exposed to opioids, the more severe withdrawal may occur.
- Dosage of the Drug: High dosage taken for long periods of time may lead to the appearance of severe withdrawal symptoms.
- Use of Other Drugs: Other drugs taken alongside opioids may affect withdrawal symptoms and their severity.
- Gestational Age: Withdrawal in premature children may be different from that which appears in full-term babies.
- Breastfeeding: Sometimes breastfeeding infants can alleviate the symptoms of withdrawal.
When to Consult a Doctor?
If you used opioids during pregnancy, regardless of being prescribed, make sure to notify your OB-GYN as soon as possible.
This is not about judgment; it is about making sure the right support is in place for both you and your baby.
You should speak to your doctor promptly if:
- You are on opioid maintenance therapy and approaching your due date
- You have concerns about your baby's behaviour or symptoms in the days after birth
- Your baby has been discharged, and you notice any of the warning signs mentioned above
- You feel overwhelmed and need additional support in caring for your newborn
A diagnosis of NOWS does not define your baby's future. With proper medical care, a nurturing environment, and the right support for the family, most babies with NOWS go on to develop and thrive. You do not have to navigate this alone. Support is always available.
Whether you’re pregnant, a new mom, or navigating postpartum, you don’t have to do it alone. Join our support group to connect, share, and support one another.
FAQs on What Is Opioid Withdrawal in Babies? A Simple Guide for Parents
- Does every baby exposed to opioids develop NOWS?
Absolutely not. It is not all newborn babies that are exposed to opioids that develop withdrawals; however, for those that do develop withdrawals, the severity of their withdrawals will be influenced by several different factors. - Are NAS and NOWS the same?
NO, while the terms sound very similar, they refer to different phenomena. Neonatal Abstinence Syndrome (NAS) is more of an umbrella term for withdrawal from any drug, and even alcohol. NOWS refers only to the withdrawal from opioids. - Can NOWS Impact my Baby’s Development?
When receiving proper medical assistance and having a nurturing home life, a majority of newborns with NOWS grow up healthy.
