- How Children's Hospital is Fighting NAS
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How Children's Hospital is Fighting NAS

Neonatal Abstinence Syndrome Baby

Neonatal abstinence syndrome (NAS) is a growing problem in Tennessee. NAS happens when babies are in contact with medications or illegal drugs in the womb. These babies form a physical dependence on the drugs used by their mothers during pregnancy. After birth, they experience withdrawal just like adults. Withdrawal symptoms vary, but can include high-pitched crying, tremors, hyperactive reflexes and inconsolability. In some cases, drug-dependent babies suffer seizures as well.

In 2014, 265 of 774 babies admitted to the Children's Hospital Neonatal Intensive Care Unit (NICU) were suffering from NAS. The neonatal team also cares for drug-dependent newborns at Fort Sanders Regional Medical Center and Parkwest Medical Center; their symptoms are not severe enough to warrant NICU admission.

The most common form of drug dependence seen in the Children's Hospital NICU are opioids, a class of drugs commonly prescribed for pain management and addiction recovery. Babies become dependent on opioids and other drugs their mothers use during pregnancy because the drugs cross the placenta, and pass from mother to baby. When infants are born with drug dependence, they are at a higher risk for heart, spinal, and intestinal defects, as well as learning and behavioral problems as they reach school age.

Faced with the growing problem of NAS, the Children's Hospital NICU staff created a better protocol for treating babies suffering from the condition. The NICU staff implemented a new, multifaceted treatment protocol that involves doctors, neonatal nurse practitioners, bedside nurses, social workers, a case manager, the rehabilitation team, and a pharmacist to develop this approach that involves evaluating neonates with NAS by using the Finnegan Scoring System (which analyzes a range of central nervous system, metabolic, gastrointestinal and respiratory symptoms). The resulting score allows the NICU staff to adjust treatment as needed.

The next important step is to get the initial symptoms of withdrawal under control without medication. Children's Hospital accomplishes this by keeping babies swaddled in private rooms. The rooms are kept quiet and dark, avoiding overstimulation. A specialized diet, baby swings and a group of trained volunteer cuddlers are also key to soothing babies with NAS.

If withdrawal symptoms are severe enough, doctors and nurses will administer small amounts of oral morphine based on the severity of the symptoms. The final goal of the protocol is weaning the baby off the medication as he becomes less dependent on a drug.

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