Neonatal Opioid Withdrawal Syndrome (NOWS)
Introduction
What is Neonatal Opioid Withdrawal Syndrome (NOWS)?
- exposure to other drugs/substances (like cigarettes or alcohol)
- the duration, degree, timing, and type of opioid exposure
- the mother’s and infant’s metabolism
- other unknown factors
What can cause NOWS?
- Morphine
- Oxycontin
- Methadone
- Tylenol with Codeine (Tylenol #3, #4, and #5)
- Subutex
- Hydromorphone
- Fentanyl
- Hydrocodone/Lortab/Norco
- Oxycodone/Percocet
- Heroin
- “Oxys”
- Marijuana
- Tobacco
- Cocaine
- Crack
- Ecstasy
- Speed
- Amphetamines
- Methamphetamines
- Alcohol
- Cigarettes/nicotine
Signs and symptoms of NOWS
- Central nervous system irritability
- High-pitched, continuous crying
- Decreased sleep
- Tremors
- Increased muscle tone
- Hyperactive Moro reflex
- Seizures
- Gastrointestinal dysfunction
- Feeding difficulties
- Vomiting
- Loose or watery stools
- Autonomic nervous system activation
- Sweating
- Fever
- Frequent yawning and sneezing
- Increased respiratory rate
- Nasal stuffiness and flaring
How can I care for my baby with NOWS?
- Work closely with your baby’s nurses and doctors to understand what to expect and to learn what works best for your baby
- Keep your baby in a dimly lit room
- Keep the room your baby is in quiet—turn off the TV, silence phones, avoid other loud noises
- Gently touch your baby and speak in a low voice
- Cuddle your baby with skin-to-skin contact
- Swaddle your baby in her blanket
- Soothe your baby by holding in an upright position and rocking with smooth motions. You can also gently rub your baby’s back, but don’t pat his back.
- Only wake your baby for feeding
- Minimize visitors
- Give your baby a pacifier
- Never shake your baby. If you feel frustrated, lay your baby down safely in her crib and take a short break.
Resources
Information & Support
For Parents and Patients
Caring for a Baby Exposed to Drugs During Pregnancy (NMDOH) ( 258 KB)
Brochure for parents and other caregivers of infants exposed to drugs during pregnancy. Provides an overview neonatal abstinence
syndrome (NAS, also referred to as NOWS, or neonatal opioid withdrawal syndrome), what causes it, and tips on how to console
your baby. From the New Mexico Department of Health.
Caring for a Baby Exposed to Drugs During Pregnancy (NMDOH) (Spanish) ( 257 KB)
Brochure in Spanish for parents and other caregivers of infants exposed to drugs during pregnancy. Provides an overview neonatal
abstinence syndrome (NAS, also referred to as NOWS, or neonatal opioid withdrawal syndrome), what causes it, and tips on how
to console your baby. From the New Mexico Department of Health.
Maternal-Infant Health and Opioid Use (AAP)
Provides resources and information about maternal opioid use and NOWS, including vercoming negative social attitudes and stigma
towards pregnant and parenting women with opioid use disorder; American Academy of Pediatrics.
Families Affected by Parental Substance Use (AAP)
This article reviews some of the short-term effects of maternal substance use during pregnancy and long-term implications
of fetal exposure, describes typical symptoms of children and adolescents in families affected by substance use, and provides
guidance for treatment; American Academy of Pediatrics
Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus (AAP)
This report will provides information about the pediatrician’s role in addressing prenatal substance exposure, including prevention,
identification of exposure, recognition of medical issues for the exposed newborn infant, protection of the infant, and follow-up
of the exposed infant; American Academy of Pediatrics.
Substance Use Screening, Brief Intervention, and Referral to Treatment (AAP)
Policy statement from the American Academy of Pediatrics to describe the concepts and terminology of screening, brief intervention,
and referral to treatment, and to offer clinical guidance about available substance use screening tools and intervention procedures.
Helpful Articles
Patrick SW, Barfield WD, Poindexter BB.
Neonatal Opioid Withdrawal Syndrome.
Pediatrics.
2020;146(5).
PubMed abstract