NEONATAL ABSTINENCE SYNDROME (NAS)- THE CARE YOUR BABY MAY NEED

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1 NEONATAL ABSTINENCE SYNDROME (NAS)- THE CARE YOUR BABY MAY NEED Information Leaflet Your Health. Our Priority.

2 Page 2 of 8 Welcome to Stepping Hill Hospital Women's Unit The aims of this leaflet are to: Help you to understand and recognise neonatal withdrawal symptoms. Suggest ways to care for your baby during this time Provide advice, encouragement and support to you, your partner and others caring for your baby. We feel it is important that you know the facts, so that you can feel reassured and confident in caring for your baby. We are here to help you to do this. What is Neonatal Abstinence Syndrome NAS? Most substances (including medication, tobacco and alcohol) taken in your pregnancy will pass through the placenta and will be absorbed by your baby. If, during your pregnancy, you have used any prescribed medication or illicit drugs that can cause physical dependency i.e. buprenorphine, codeine, heroin, methadone, benzodiazepines and some anti-depressants, your baby may become dependent on this medication too. Could my baby be affected? Following delivery, when the umbilical cord has been cut, the supply of drugs to the baby suddenly ceases and the baby may show signs of physical withdrawal known as Neonatal Abstinence Syndrome (NAS). This withdrawal process and effects are similar to that experienced by an adult who suddenly stops taking a drug or medication. Could my baby be affected? Most babies exposed to drugs/medication before birth will experience some symptoms after the birth. Some babies may only show signs of mild withdrawal, requiring no more than the usual care given to all babies. However, there are some babies who may have moderate or severe withdrawal symptoms which affects how well they feed and sleep. These babies may require more specialised care and medical treatment to help them as they withdraw (as would an adult during a planned detox). Unfortunately, as each baby is an individual, there is no way of knowing if a baby will experience mild or severe withdrawal following birth. Research does suggest that babies exposed to maternal multiple drug use and unstable treatment during pregnancy may be at increased risk of NAS in the baby. During pregnancy, it is important to access antenatal care. Treatment for illicit drug or alcohol use and monitoring of the effects of prescribed medication will help to reduce the risks of NAS and improve the health and wellbeing of both mother and baby.

3 Page 3 of 8 What will happen after the birth? Wherever possible, both you and your baby will stay together on the maternity ward. Your baby would only be admitted to the Neonatal Unit, because of NAS if she/he needs medication for severe withdrawal and further monitoring. Breastfeeding is encouraged to help with any withdrawal, as well as enabling bonding with your baby. The use of some drugs means that this is contra-indicated, and your midwife will be able to advise about this. Most babies do not need treatment for NAS, and will be able to go home after a period of observation. Babies are observed for a minimum of 72 hours, but may need a longer period. This is because withdrawal symptoms may not be apparent immediately after delivery and may develop over a few days or even weeks. Midwifery staff will always explain and discuss any treatment or medication your baby may require with you, your partner and others caring for the baby. What are the signs and symptoms of NAS? Neonatal Withdrawal Symptoms include: A continuous high-pitched cry Irritability and restlessness Tremor (shaking) of arms and legs whether disturbed or resting Increased muscle tone where the limbs feel very stiff Feeding difficulties (difficulty in sucking or swallowing) Excessive wakefulness - Not settling or sleeping after a feed Vomiting / diarrhoea Fever hot to touch Excessive sneezing, yawning, hiccups Less commonly fits (convulsions). Midwives on the ward will be able to monitor your baby for any signs of NAS, using a withdrawal chart, which they will show you how to fill in, as part of the care for your baby. Scoring for symptoms should take place every 3 to 4 hours, depending on your baby s feeding pattern and behaviour. If the withdrawal symptoms are increasing, your baby will be monitored more frequently 2 hourly. Severe withdrawal symptoms or convulsions will require treatment and your baby will need to be admitted to the Neonatal Unit for this period. Some babies can still experience withdrawal after they have been discharged from hospital. You can contact your midwife, health visitor, GP or E.D. Dept if you are concerned.

4 Page 4 of 8 Never give your baby any drugs or medication that has not been specifically prescribed for your baby by your GP or by the hospital. What can I do to help care for my baby? Most babies do not require medical treatment for NAS however there are things that you can do which will help your baby to withdraw safely and comfortably. Remember, each baby is an individual and the withdrawal process will vary from baby to baby. Provide a quiet environment with dimmed lighting to reduce the stimulation from around the baby. Turning down loud music/tv/voices will help the baby to settle if they are crying, irritable or unable to sleep. Cuddle your baby as much as possible, skin-to-skin contact. This will help your baby be calmer, cry less and feed better. Handle and move your baby very gently to help reduce irritability and crying. Gentle baby massage or bathing can be soothing. Discourage visitors from picking up your baby once they are settled. Dress your baby in cool clothing, and change frequently if they are sweating. If they are restless and irritable, a cool sheet can be used to swaddle the baby to avoid getting too hot. Slings can be useful when you are at home. Dummies can be helpful unless you are breastfeeding, if your baby is excessively sucking or to settle the baby. Change your baby regularly. Your baby s bottom may get sore due to loose stools/diarrhoea. More frequent nappy changes may be needed and barrier creams can be helpful. Feed your baby regularly. Smaller feeds are normally better. Help with feeding may be required from your midwife if your baby has problems sucking or is vomiting. Keep a record of all your baby s feeds to help your midwife monitor any problems. Avoid smoking cigarettes or illicit drugs around the baby and follow the guidelines around sleeping positions and passive smoking. Do not share your bed with your baby If your baby sneezes, they may have a blocked nose. Gently wipe the nose if it is dirty, but do not clean with cotton wool buds as doing this can damage your baby s nose.

5 Page 5 of 8 If your baby appears pale, blue or grey in colour, has breathing difficulties or appears to be panting, has a fit/convulsion or is floppy or stops breathing dial 999 immediately and call for medical aid. Babies on the Neonatal Unit If your baby is admitted to the Neonatal Unit, you are encouraged to be actively involved in his / her care. The Unit has an open visiting policy for parents You will be given an information leaflet if your baby is admitted to the Neonatal Unit which will explain about visiting. What else do I need to know? Hepatitis B Vaccine may be offered to your baby to help to protect him / her. This will be discussed with you before your delivery. Most women who use drugs or prescribed medication have a normal pregnancy, labour and delivery. Many babies who are born experiencing drug withdrawal symptoms will recover fully in time, but some may experience long term consequences such as behavioural issues and developmental problems. Follow up will be arranged with a Paediatrician after discharge if this is appropriate. Babies who are withdrawing may be demanding to care for and this can be difficult time for some mothers who may feel guilt and blame. Your community midwife, specialist midwives, neonatal staff, health visitors and community drug/alcohol team workers are always available to talk to you about any worries, concerns or questions you and your family may have. Reference: Substance Misuse in pregnancy: a resource book for professionals. Drugscope 2005

6 Page 6 of 8 Useful Telephone Numbers and Web Site Addresses Maternity Triage Stepping Hill Hospital ( ) 24hour Stepping Hill Hospital Antenatal Clinic: Specialist Midwife Vulnerable Groups Mosaic (Stockport Young People Drug & Alcohol service for 25 year olds and under) ( ). Stockport Community Alcohol Team: Stockport Community Drug Team (CDT) (Stockport residents only) Stockport Women s Centre: Senior Public Health Advisor (Alcohol) NHS Stockport Corbar Maternity Unit: Derbyshire Alcohol Advice Service: (Derbyshire residents only) Neil Short, Alcohol Specialist Nurse: Community Drug Team Buxton/Chesterfield Matlock Community Drug Team AA (Alcoholics Anonymous): (London: / ) Alcohol Concern: Patient & Customer Services: Oak House, Stepping Hill Hospital Need extra information, support or advice? Contact a Supervisor of Midwives by ringing the main switchboard at Stepping Hill Hospital: A Supervisor of Midwives is available 24 hours a day. Supervisors are concerned with ensuring the safety and well-being of mother and baby and with the provision of high quality midwifery care.

7 Page 7 of 8 Contact us Antenatal Clinic Triage Department Neonatal Unit NHS Choices website

8 Page 8 of 8 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Information Leaflet. PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MAT177 Publication date January 2014 Review date January 2017 Department Neonatal Unit Location Stepping Hill Hospital