Managing Neonatal Withdrawal Symptoms

In honor of National Neonatal Intensive Care Awareness Month, I wanted to shed some light on methods to help manage neonatal abstinence syndrome (NAS). As a nurse with over 16 years of experience and 11 of which have been in the NICU, I have seen my share of withdrawing babies, and it’s not for the faint of heart.

The Causes and Symptoms of NAS

Every year, over 20,000 U.S. babies are born with maternal drug and substance use exposure. Pregnant mothers who take pain medications like codeine, morphine, Vicodin, Percocet, etc., are at risk of having a baby born with NAS. Mothers using methadone to treat heroin use will likely have babies admitted to the NICU for withdrawal.

The symptoms of NAS can range from minimal to severe and can include the following characteristics:

• Extreme fussiness, high-pitched crying, and inability to console

• Tremors, convulsions, seizures

• Repetitive sneezing and yawning

• Developmental delay

• Breathing difficulty

• Diarrhea and vomiting

• Excessive sweating

• Problems sleeping

• Poor feeding

• Prematurity

Babies with substance use exposure, including cigarettes, marijuana, and alcohol are at a higher risk of dying from sudden infant death syndrome (SIDS).

Common NAS Treatments

Treatment of NAS includes both environmental and pharmaceutical methods and depends on the type of substance the mother used during pregnancy, the gestational age of the baby, the overall health of the baby, and the severity of symptoms. Common NAS environmental treatments include the following:

• Keeping the baby in a dark, quiet environment

• Swaddling the arms and legs

• Skin-to-skin (kangaroo) holding

• Gentle rocking motions

• The use of white noise

Medications used in the treatment of NAS may include clonidine and opioids like morphine, buprenorphine, or methadone. Barbiturate medications like phenobarbital are also commonly used to help treat seizures, tremors, and muscle stiffness.

A New Approach for NAS Withdrawal

The company Prapela has developed a groundbreaking vibrating mattress pad that not only helps treat apnea of prematurity (when premature babies stop breathing) but is also effective for NAS symptom management. Using this unique vibration therapy helps to reduce the need for morphine treatment.

I specifically remember sitting next to the bed of a withdrawing baby and gently tapping her back. It was the only action that would help calm her. She couldn’t tolerate being held, and her medication treatment only helped so much. At that moment, I thought, I wish someone would create a mechanical hand tapper or a vibrating mattress. Thank you, Prapela, for your ingenuity and for taking NAS treatment to the next level.