OPIOID EXPOSURE
Q What is neonatal abstinence syndrome?
A Known as NAS, it is a constellation of issues in newborns born to mothers exposed to opioids in pregnancy.
Q What are the symptoms of NAS?
A They include trembling, crying, tight muscle tone, seizures, yawning, stuffy nose and sneezing. Symptoms may take a few days to appear. Other effects, such as irritability, sleep disorders and feeding problems can last for four to six months. The intensity of withdrawal symptoms varies, depending on the type of opioid used, the frequency, dose and timing of last exposure, and the mother’s metabolism and use of other substances. “Some people will say these babies are born addicted. That’s a fallacy. They’re physically dependent,” says neonatologist Dr. Kimberly Dow.
Q What kind of opioids have these babies been exposed to?
A There are three types of possible exposure: illicit opioids, such as heroin (or synthetic drugs such as fentanyl); prescription opioids, such as oxycodone and, third, replacement opioids such as methadone.
Q What are the Canadian Paediatric Society recommendations for NAS?
A Keeping mothers and babies together is essential to both in the long and the short term, says the society in a guidance document. The society also recommends that newborns exposed to opioids be observed for at least 72 hours after delivery and assessed to determine whether additional monitoring and medication are needed. Breastfeeding should be encouraged because it can delay the onset and decrease the severity of withdrawal symptoms, as well as decrease the need for pharmacological treatment. Once newborns are ready for discharge from hospital, a wellcoordinated plan involving a team of health-care professionals is essential to ensure that once they are home, the babies continue to sleep and eat well, gain weight and adapt to their environment, says the CPS. This includes community resources to support keeping infants and their mothers together long after they leave hospital.
Q What is the long-term prognosis for these babies?
A Good, it appears, although there have been few studies on long-term outcomes. Early in childhood, NAS babies may display minor learning difficulties, slower speech acquisition or behavioural issues. They also tend to have sleep disturbance for the first one to three months of life. However, there have been no reports of health or major neurodevelopmental issues. “The question is whether it is a response to the drug, or one of a myriad of social issues. We certainly believe that providing intensive supports and keeping mother and baby together helps to mitigate the effects. But we don’t have proof,” says pediatrician Dr. Thierry Lacaze. “When we send these babies home, they don’t have health issues. It’s a transient problem, most of the time.”