Does your newborn have these problems? Let's talk about Neonatal Opioid Withdrawal Syndrome (NOWS)

The joy a mother feels when she brings home a newborn baby is indescribable. But sometimes, if the baby keeps crying, spits up milk frequently, or seems to be acting strangely, it can be very scary for a mother. Today we are going to talk about one such scary but important condition that we need to be aware of. That is Neonatal Opioid Withdrawal Syndrome (NOWS) in newborns. Previously, it was also called Neonatal Abstinence Syndrome (NAS) .

What is neonatal opioid withdrawal syndrome (NOWS)?

Simply put, this is when the mother uses certain drugs (especially opioids) or other addictive substances during pregnancy, and the baby is exposed to those substances while in the womb, and the discomfort that occurs after the substances are removed from the body after birth. Did you know that when the baby is in the womb, it receives nutrients and oxygen from the mother through an organ called the placenta . Similarly, some medications and drugs that the mother takes also pass through this placenta to the baby. So, while the baby is in the womb, it becomes accustomed to these substances in a way, that is, it begins to depend on them. When the supply from the mother stops after birth, the baby's body has a hard time coping with it. That's when these withdrawal symptoms appear.

What drugs can cause NOWS?

This condition is mainly caused by drugs in the opioid class. Here are a few examples:

• `( Amphetamines )`
• `( Buprenorphine )`
• `(Codeine)`
• `(Heroin)`
• `( Oxycodone )`
• `( Hydrocodone )`
• `(Morphine)`
• `(Methadone)`

In addition to this, some other substances can also cause this condition. They are:

• Alcohol
• Barbiturates (some types of sleeping pills)
• Benzodiazepines (some sedatives)
• Nicotine (contained in tobacco )
• Some types of antidepressants, especially those in the group called Selective Serotonin Reuptake Inhibitors (SSRIs).

Most importantly, if you are pregnant or planning to become pregnant, you should definitely inform your doctor about any medications, supplements, or other substances you are taking.

Is this condition common? Who is most affected?

This NOWS condition is unfortunately reported to be increasing worldwide. In fact, according to statistics, according to some studies, one baby is born with NOWS every 25 minutes. That means that about seven out of every two thousand babies may have this risk. This mostly affects newborns whose mothers used opioids or other addictive substances during pregnancy. Drug addiction is not as simple as it seems, it is a complex issue.

What happens to the baby's body due to NOWS? What are the symptoms?

These symptoms, known as withdrawal symptoms, may persist until the baby is completely off the drug. This can cause the baby to cry a lot, become very restless, or act sick. How difficult is it for a new mother or father to see their little one suffering like this? It can also be very difficult to comfort the baby during this time. Depending on the severity of the baby's symptoms, the baby may need to be treated in the Neonatal Intensive Care Unit (NICU) . This is until the baby is completely off the drug and is doing well. Common Symptoms:

• Frequent vomiting and/or diarrhea
• Fever and sweating
• Rapid breathing
• Continuous, loud crying
• Frequent sucking
• Tremors
• Diaper rash (redness of the skin in the buttocks area due to diaper rash)

Additional symptoms that may be seen:

• Muscle stiffness (Hypertonia) and overactive reflexes
• Difficulty gaining weight
• Difficulty falling asleep and staying asleep
• Problems with drinking milk
• The appearance of a mottled, marble-like pattern on the skin (mottling)

These symptoms can vary from one baby to another, and the severity can vary. It depends on:

• It depends on what type of drug is in the baby's body.
• It depends on how much of the drug is in the body.
• It depends on how long the baby was exposed to the drug while in the womb.

What if the symptoms get worse?

If a baby has too much of the drug in their body at birth, they can develop severe, even life-threatening symptoms. These include:

• Premature birth
• Developmental problems and birth defects
• Seizures
• Sudden Infant Death Syndrome (SIDS)

When do symptoms appear?

These symptoms can start to appear within a day or three after the baby is born. Sometimes, symptoms may not appear for up to a week. During this time, the baby is often kept in the hospital's ``NICU'' until the substance has completely cleared from the body and the baby is well enough to go home.

Can NOWS cause long-term effects?

This is a very sensitive issue. The long-term effects can vary depending on the severity of the NOWS condition. As the child grows older, they may experience things like:

• Developmental delays : Delays in the development of cognitive, social, and motor skills.
• Behavioral problems at school.
• Problems with short-term memory.
• Growth problems (height, weight loss).
• Hearing and vision problems.

Therefore, it is very important to take your baby for regular wellness checkups to ensure that he or she is meeting developmental milestones for his or her age. Studies have shown that children born with NOWS are more likely to develop the following conditions as they grow up:

• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Anxiety
• Depression

How to identify NOWS status?

Because the symptoms of NOWS can be similar to those of other conditions in newborns, doctors can only diagnose the condition after learning about the drugs the mother took during pregnancy and after performing a drug screen . This drug screen can find out what type of drug is in the baby's body and how much. This can be done by testing a sample of the baby's umbilical cord, urine, blood, or the baby's first stool (meconium). Sometimes the mother may also be tested for drugs to confirm the diagnosis. In addition, doctors use a NAS scoring system . This is used to give a score based on the severity of the baby's symptoms and plan treatment accordingly.

What are the treatments for NOWS?

The treatment given to the baby depends on the type of drug in the body, the amount of it, the baby's overall health, and the severity of the symptoms. Treatment may include:

• Giving medication to gradually reduce symptoms.
• If the baby is dehydrated, give saline intravenously (IV fluids).
• Applying creams or ointments for nappy rash and skin irritations.
• Changing the frequency and amount of breastfeeding: To help your baby gain weight, give a high-calorie formula in small, frequent amounts.

Treatment can last from five days to about six months, until the baby is well and there are no more drugs left in their body. Long-term treatments to reduce symptoms, such as cognitive behavioral therapy (CBT) , may be needed throughout the child's life.

What types of medications are given for NOWS?

If your baby has severe symptoms, doctors may use some medications to help control these withdrawal symptoms and help your baby eat and sleep better. This involves giving your baby a very low dose of a drug similar to the one they received in the womb, gradually reducing the dose, and weaning the baby off of it. This is because stopping the drug suddenly (cold turkey) can make the symptoms worse. Some of the medications used for this purpose include:

• `(Methadone)`
• `(Morphine)`
• `(Buprenorphine)`
• `(Phenobarbital)`
• `(Clonidine)`

If your baby needs to be medicated in this way, you may need to stay in the hospital for a few weeks or months. This is to ensure that the doctors are healthy enough to stop the medication completely and send the baby home.

How can the mother help manage her baby's symptoms?

When your baby is suffering from withdrawal symptoms, it can be very stressful and difficult to comfort them. But as a mother, you can help by:

• Stay close to the baby as much as possible.
• Reduce the amount of bright light and loud noise in the baby's environment.
• Rock the baby gently.
• Hold your baby close to your chest ( skin-to-skin contact ). This is very comforting for your baby.
• Wrap the baby well in a soft cloth (swaddling).

Can I breastfeed my baby while taking drugs?

This is a very important issue. Yes, drugs like opioids can pass into your baby's breast milk. This can have dangerous side effects for your baby. So, if you are using drugs that are not approved by your doctor, do not breastfeed your baby for any reason . Instead, give your baby formula or donated breast milk. However, if you are in a drug treatment program, that is, if you are taking a prescribed opioid (such as methadone) during pregnancy or after giving birth to prevent withdrawal symptoms, you may be able to breastfeed. But only with your doctor's approval and if they decide it is safe for your baby. If you have a drug problem or addiction, talk to your doctor about ways to get treatment for it. Staying healthy will give you the strength to be there for your child when they need you most.

How to prevent NOWS?

You can take these steps to prevent your baby from developing severe symptoms of NOWS:

• If you become pregnant, be sure to tell your doctor about any drugs or substances you are using. If you suddenly stop using a drug you have been using for a long time, you may have severe withdrawal symptoms, which can be harmful to your unborn baby. Your doctor will recommend treatment options that are safe for both you and your baby.
• Tell your doctor about any prescription medicine and supplements you are taking. Make sure they are safe for both you and your baby. Do not stop taking any medicine until your doctor tells you to.
• Use contraception until you are ready to have a baby. If you are sexually active and have a drug use problem or are in treatment for it, practice safe sex until you are healthy enough to get pregnant.

If my baby has NOWS, what should I expect?

A baby diagnosed with NOWS usually stays in the hospital for about 20 days to make sure they are well enough to go home. Sometimes NOWS treatment can last up to six months. Doctors will monitor your baby's symptoms closely and send them home only after the drugs have completely cleared from their system. Your doctor will give you advice on how to breastfeed your baby and how to care for your baby. Remember, if you are using drugs, do not breastfeed, as the drugs can pass to your baby through your breast milk and cause symptoms that can affect his health. After you bring your baby home from the hospital, your baby will need your extra love and support for several weeks or months, and perhaps throughout childhood. Pay close attention to your baby's growth and development. If your baby is not meeting developmental milestones for his age, tell your doctor right away.

When should you seek emergency treatment?

If your baby has these severe symptoms, go to the Emergency Department (ETU) immediately or call 1990:

• High fever lasting more than 24 hours.
• If you don't drink milk, or if you vomit after drinking milk.
• If a seizure occurs.
• If the heartbeat is abnormal.
• If you have difficulty breathing.

What are the important questions to ask the doctor?

• What medications are safe to take during pregnancy?
• How do you quit using an addictive drug?
• Will my baby's symptoms affect him long-term?
• How can I comfort my baby during treatment?

Finally, what to remember (Take-Home Message)

Drug addiction is a really challenging and overwhelming thing. When you're pregnant, these feelings can be even more intense, and you may feel like you don't know what to do. But remember, you're not alone.

There are treatments available to help you and your baby live a happy, healthy life. The most important thing is to be honest with your doctor about all the medications and drugs you take during your pregnancy. This will help your doctor determine the best treatment for you and your baby. There is nothing wrong with asking for help, it is empowering.

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