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Neonatal abstinence syndrome

Lauren M Jansson, MD
Section Editor
Joseph A Garcia-Prats, MD
Deputy Editor
Melanie S Kim, MD


A newborn infant born to a mother with an opioid use disorder or using/taking other substances is at risk for drug withdrawal, commonly referred to as neonatal abstinence syndrome (NAS). NAS is a variable, complex, and incompletely understood spectrum of signs of neonatal behavioral dysregulation.

Although most commonly associated with opioid exposure, other substances have been associated with an abstinence syndrome, including nicotine. Additionally, other substances, such as cigarettes, benzodiazepines, and selective serotonin reuptake inhibitors (SSRIs), can potentiate the severity of NAS.

The clinical manifestations, diagnosis, and management of NAS will be reviewed here. Opioid use during pregnancy and neonatal exposure to other drugs of substance use disorder are reviewed separately. (See "Infants of mothers with substance use disorder" and "Substance misuse in pregnant women" and "Methadone substitution therapy of opioid use disorder during pregnancy".)


The term opioid refers to natural and synthetic substances with morphine-like activities that activate mu-opioid receptors in the central nervous system and gastrointestinal tract. Opiate refers to a subclass of opioids consisting of alkaloid compounds extracted or derived from opium that include morphine, codeine, and semisynthetic derivatives such as heroin, methadone, fentanyl, hydromorphone, and buprenorphine. (See "Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis".)

Pregnant women with substance use disorders who are dependent on opioids are generally maintained on methadone, which provides multiple benefits including improved prenatal care, reduced fetal mortality, and improved fetal growth [1]. Buprenorphine has become an acceptable alternate opioid during pregnancy with potential benefit for reduced severity of NAS [2]. The management of pregnant women dependent on opioids is discussed separately. (See "Substance misuse in pregnant women" and "Methadone substitution therapy of opioid use disorder during pregnancy" and "Buprenorphine substitution therapy of opioid use disorder during pregnancy".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 12, 2017.
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