Neonatal Abstinence Syndrome

pregnant woman holding medication

Neonatal Abstinence Syndrome (NAS) is a drug withdrawal syndrome that results from the abrupt discontinuation of chronic fetal exposure to substances that were used or abused by the mother during pregnancy.

Because the mother and baby share blood circulation through the placenta during pregnancy, almost every drug that the mother uses passes to the baby. When the baby is born, it is still physically dependent on the drug and may begin to show symptoms of withdrawal. Symptoms can include tremors, excessive crying, excessive sucking, poor feeding, sweating, vomiting, diarrhea, blotchy skin, hyperactive reflexes, and occasionally, seizures.

NAS most often is caused when a woman takes opioids (e.g. morphine, methadone, oxycodone) during pregnancy, but can also occur with benzodiazepines (e.g., diazepam, alprazolam, clonazepam) and barbiturates (e.g., phenobarbital, Seconal, butalbital). It also can occur when a woman is using illegal drugs, such as heroin, cocaine, and methamphetamine.

NAS is a Notifiable Condition in Georgia as of January 1, 2016 under the Official Code of Georgia Annotated (OCGA) section 31-12-2. OCGA 31-12-2 states the following:

The department shall require notice and reporting of incidents of neonatal abstinence syndrome. A health care provider, coroner, or medical examiner, or any other person or entity the department determines has knowledge of diagnosis or health outcomes related, directly or indirectly, to neonatal abstinence syndrome shall report incidents of neonatal abstinence syndrome to the department.

In addition to signs and symptoms, the following toxicology results are reportable to DPH:

  • Toxicology indicating positive results for any opioids, benzodiazepines, or barbiturates (OBB) in any specimen from infants less than 28 days old
  • If available, toxicology indicating positive results for any OBB in maternal specimen (e.g., urine, blood) in the four weeks prior to delivery 
  • If toxicology is positive for any OBB, positive results for all substances should be reported

Identifying information must also be reported to ensure accurate case counts and referrals to early intervention services. Gathering information about the incidence of NAS will help DPH to develop policies and programs aimed at reducing the number of babies who are born with NAS. 



National Case Definition (reporting guidelines):

Healthcare Providers:



Questions related to NAS:

Email: [email protected]


Page last updated 12/15/2022