Neonatal Abstinence Syndrome
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):
- Council for State and Territorial Epidemiologists (CSTE) Neonatal Abstinence Syndrome Position Statement (approved June 2019): https://cdn.ymaws.com/www.cste.org/resource/resmgr/2019ps/final/19-MCH-01_final_7.31.19.pdf
- ACOG Committee Opinion "Alcohol Abuse and Other Substance Use Disorders: Ethical Issues in Obstetric and Gynecologic Practice"
- AAP The Committee on Drugs, The Committee on the Fetus and Newborn "Neonatal Drug Withdrawal"
- CDC Guideline for Prescribing Opioids for Chronic Pain
- SAMHSA – Behavioral Health Treatment Services Locator
- Healthy Mothers, Healthy Babies Powerline – 800-300-9003
- Stop Rx Abuse in GA – Video "Prescription Drug Abuse and Your Pregnancy"
- Mother to Baby
Questions related to NAS:
Media Relations / Office of Communications
Page last updated 5/7/2019