Neonatal Abstinence Syndrome (NAS) Clinic

The Neonatal Abstinence Syndrome (NAS) Follow-Up Clinic at Johns Hopkins All Children’s Hospital treats babies born at 35 or more weeks of gestation who have been exposed to certain types of medicines or drugs in utero.

NAS is a condition that occurs when a mother becomes pregnant while using opioids or other addictive drugs. The infant may begin to experience symptoms of withdrawal once they are born and are no longer receiving the opioids or drugs, causing a variety of symptoms such as tremors, irritability, weight loss and in rare cases, seizures. Newborns may require pharmacological treatment, which may include small doses of a drug in the same family as what the mother took throughout pregnancy.

New Solutions To National Issue

On average, Johns Hopkins All Children’s treats 100 newborns with NAS every year. Newborns with NAS need to be held and comforted constantly to ease their symptoms. The optimal environment is a quiet, dark place, away from bright lights and loud noises. Johns Hopkins All Children’s adapted these principles by creating a quiet physical space in the NICU for these babies and training a team of nurses to provide non-pharmacological comforting measures around the clock.

Neonatal Abstinence Syndrome Symptoms

Withdrawal can occur in different ways, and every baby may show symptoms of withdrawal in a different way. It is not possible to predict which baby will have withdrawal, how long symptoms will last or the severity of his or her symptoms.

When does withdrawal start?

Withdrawal usually starts within two to three days after birth, but may not be obvious until five to seven days after birth. Babies stay in the hospital for a minimum of five to seven days so that they can be observed for signs of withdrawal.

Common symptoms of withdrawal:

A high-pitched cry that does not stop with soothing
Trouble sleeping
Tremors or jitteriness, awake or asleep
Tight muscles
Sweating
High temperature
Frequent yawning or sneezing
Fast breathing
Excessive sucking or poor feeding
Throwing up a lot
Diarrhea that can cause diaper rash

What to Expect

Your baby will be seen by a pediatrician or nurse practitioner, occupational therapist, neurodevelopmental psychologist and a feeding specialist trained to take care of babies and toddlers. These therapists can identify any difficulties your baby may have and assist with providing therapy.

A follow-up appointment will be made for you within two to four weeks of your baby’s hospital discharge. The medical team will provide developmental follow-up and education for you and your baby at 4, 8 and 18 months of age.

At 12 months of age, your baby will be scheduled for an appointment with our pediatric neuropsychologist for a neurodevelopmental evaluation and will be seen annually until the age of 5.

These appointments do not replace your pediatrician appointments, but offer specialized services for your baby for their diagnosis of NAS.