Understanding Neonatal Opioid Withdrawal Syndrome (NOWS)

What is Neonatal Opioid Withdrawal Syndrome?

Neonatal Opioid Withdrawal Syndrome (NOWS) is a treatable health issue that a baby may go through as a result of being exposed to opioids before birth.

What are the symptoms of NOWS?

Each newborn is affected differently and will have different symptoms. Some of the likely symptoms a baby may go through are:

  • irritability (crankiness, fussiness)
  • trouble sleeping
  • high-pitched cry
  • tight muscles, stiff arms/legs/back
  • yawns a lot
  • shaking or trembling
  • difficulty with feeding
  • vomiting
  • loose and watery stools
  • poor weight gain
  • skin breakdown from loose, watery stools and from restlessness

Most newborns show signs of withdrawal between 1 and 5 days after birth based on how much, how long, and what kind of medicine or drug the newborn was exposed to before birth.

How do we know if a baby has NOWS?

  • The newborns caregiver and the healthcare team caring for the newborn will work together to watch for signs of withdrawal and how the newborn is tolerating withdrawal.
  • A method called “Eat, Sleep, and Console” (ESC) will be used to tell how the newborn is tolerating withdrawal.
    • If the newborn is able to eat well, sleep well, and be consoled easily that baby is tolerating withdrawal.
    • If the newborn is not able to eat well, sleep well, and/or be consoled easily that newborn may need more support to help them with their withdrawal. This extra support may or may not include medications.

How is NOWS treated?

  • Having the caregiver(s) present and involved in the care of the newborn is one of the best treatments for NOWS.
    • Stay close to newborn.
    • Swaddle and hold newborn.
    • Hold newborn skin-to-skin.
    • Feed newborn when hungry.
    • Keep room quiet and calm.
    • Offer a pacifier.
    • Breastfeed newborn.
  • If the newborn has a problem eating, sleeping, or being consoled after attempting and/or increasing steps to help comfort the newborn, medication may be needed. Medication may be used only on an as needed basis or may be scheduled every few hours.

When can a baby with NOWS go home?

  • Newborns at risk for NOWS will stay in the hospital for at least 3 days (72 hours).
  • Based on what symptoms the newborn is going through and what treatment is needed to help with the symptoms, the newborn may need to stay in the hospital for 1-4 weeks or longer.
  • The baby with NOWS is ready to go home when:
    • Watching for symptoms of NOWS is complete. This will depend on how much, how long, and what kind of medicine or drug the newborn was exposed to before birth.
    • Able to eat, sleep, and be consoled without a problem.
    • Able to keep a normal heart rate, breathing rate, and temperature.
    • If medicine is being used, the newborn must stay at the hospital.

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This information is not intended as a substitute for professional medical care. Always follow your health care provider’s instructions.