Every 25 minutes, an infant in the United States is diagnosed with neonatal opioid withdrawal syndrome (NOWS), according to one estimate. NOWS occurs when a baby who was exposed to opioids during pregnancy develops withdrawal after birth.

Because NOWS can be difficult to quantify, it’s useful for new and expectant parents to know what the condition can look like. We’ll cover the causes, symptoms, and treatment of NOWS in newborns.

What Is NOWS?

Neonatal opioid withdrawal syndrome is opioid withdrawal that can develop in a newborn after exposure to opioids before birth. This exposure can happen when a pregnant person uses prescription or nonprescription opioids, such as morphine, oxycodone, or heroin. Babies can experience withdrawal after birth because the opioid exposure through the placenta (​​a temporary organ that provides the baby with nutrients) suddenly stops.

NOWS can also occur when a pregnant person receives methadone or buprenorphine as part of medications for opioid use disorder (MOUD), even as prescribed. Still, health experts recommend MOUD for opioid use disorder (OUD) during pregnancy rather than going without OUD treatment. Talk to your healthcare provider about your OUD treatment options during pregnancy.

How Is NOWS Treated?

Hospital stays and treatment length can vary. A large U.S. study found that the time until babies were medically ready for discharge differed by care approach, and Cleveland Clinic notes that treatment can last up to six months. Exact treatment plans depend on the severity of NOWS, the type and amount of opioids involved, and the baby’s overall health.

First-Line Treatment

Doctors often start treating NOWS with nondrug care. First-line nondrug strategies may include the following:

Rooming In

Rooming in means the newborn is kept in the same room with the mother while in the hospital. When possible, this gives the mother and baby more opportunities to bond, and rooming in may reduce the severity of NOWS symptoms.

Breastfeeding Support

Research shows that breastfeeding can reduce the severity of NOWS symptoms and shorten hospital stays. People who want to breastfeed should receive support from professionals who can offer guidance.

Health experts generally recommend exclusive breastfeeding for around six months, with continued breastfeeding for as long as the parent and baby would like.

Breastfeeding isn’t recommended in some situations, including active use of nonprescribed opioids or other drugs. It’s usually safe to breastfeed while receiving MOUD and being in stable recovery, unless the care team identifies another reason not to.

Skin-to-Skin Contact

Skin-to-skin contact can help soothe a baby with NOWS. Babies may also feel more comfortable when being swaddled or gently rocked.

Low-Stimulation Environment

A low-stimulation environment may make withdrawal more comfortable at home or in the hospital. Keeping the lights low, noise minimal, and limiting visitors can reduce stimulation.

The ESC Approach

The Eat, Sleep, Console (ESC) approach is a newer way to assess and manage NOWS. The ESC approach involves nondrug care such as a low-stimulation environment, breastfeeding, skin-to-skin contact, and caregiver involvement.

One ESC protocol assesses the baby for the following abilities to help guide treatment:

• Eat at least 1 ounce during a feeding
• Sleep for at least one hour without waking
• Be consoled by a parent or caregiver within 10 minutes of crying

In one large trial, babies treated using the ESC approach were 63 percent less likely to receive opioid medication than babies assessed with the traditional Finnegan Neonatal Abstinence Scoring Tool (FNAST). On average, babies receiving ESC care were also medically ready for discharge about 6.7 days earlier.

Medications for Severe Withdrawal

When withdrawal symptoms are severe or don’t improve with ESC, babies with NOWS may need medication.

Doctors may prescribe methadone or morphine to lessen withdrawal symptoms. Small doses can help wean the baby off opioids gradually. With symptoms better controlled, the baby may sleep and eat more easily.

Join the Conversation

On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.

How have you found support for an infant with NOWS? Let others know in the comments below.