This online Guideline is applicable to all UK Medical, Nursing and Midwifery staff caring for babies in the hospital or community setting within the West of Scotland. Staff should be aware of the appropriate drug monographs and other applicable guidelines, which will include the immunisation guideline as well as guidelines for the management of babies born to mothers with vertically transmissible viral infections (HIV, Hepatitis B and C).

Neonatal Abstinence Syndrome (NAS) is a constellation of symptoms occurring in a baby as a result of withdrawal from physically addictive substances taken by the mother. These substances include (but not exclusively) methadone and other opioids, heroin, benzodiazepines, cocaine and amphetamines as well as caffeine, nicotine and some antidepressant agents. Almost all opioid dependent mothers smoke in pregnancy, and a significant number probably also consume excess significant amounts of alcohol in pregnancy. The majority of infants with NAS in the West of Scotland will be withdrawing from opioids ± benzodiazepines; it is not know if, or by how much nicotine and/or alcohol withdrawal also play a part. (1,2).

While the majority of cases of NAS occur in infants born to mothers with a history of substance misuse, it is also possible for a neonate to develop NAS following in utero exposure to opioids prescribed for the treatment of chronic pain.