Neonatal Abstinence Syndrome: Nursing Diagnosis

Nursing Knowledge

Neonatal Abstinence Syndrome: Nursing Diagnosis

Neonatal abstinence syndrome (NAS) is a multisystemic disorder in newborns who were exposed to addictive substances during pregnancy and are suffering from withdrawal after birth. Symptoms like high-pitched cries, irritability, tremors, feeding difficulties, and sleep disturbances can point to the condition. Keep reading for a concise nursing overview of NAS including signs and symptoms, possible long-term effects, and nursing diagnoses.

Last updated: December 15, 2025

What is neonatal abstinence syndrome?

Neonatal abstinence syndrome (NAS) is a multisystemic disorder resulting from chronic in-utero exposure to certain prescription or illicit drugs and their abrupt cessation at birth.

Causes of NAS

NAS can result from a wide variety of substances consumed during pregnancy, including:

Opioids
- Heroin
- Morphine
- Fentanyl
- Hydrocodone
- Oxycodone
- Methadone
- Buprenorphine
Benzodiazepines
Amphetamines
Cocaine
Nicotine
Antidepressants (SSRIs, SNRIs)

Is neonatal abstinence syndrome a disability?

NAS itself is not a disability, but a temporary condition that newborns experience after being exposed to addictive substances during the pregnancy. However, more severe cases can come with co-occurring conditions that may result in long-term problems or disabilities.

Long-term effects of neonatal abstinence syndrome

Some of the long-term effects of neonatal abstinence syndrome can include:

Developmental delays
Behavioral and learning problems
Possible issues with growth, feeding, development, hearing, and vision
Increased risk of SIDS

Symptoms of neonatal abstinence syndrome

Onset, duration, and severity of symptoms vary greatly depending on the substance(s) involved and patterns of prenatal use.

List of potential symptoms of NAS:

High-pitched cry
Hyperirritability
Seizures
Sleep deprivation and fragmentation
Tachypnea
Sneezing
Hypertension
Sweating
Tachycardia
Diarrhea
Excessive weight loss
Vomiting
Excessive sucking
Poor or excessive feeding
Yawning
Hyperthermia
Hypertonia
Tremors

Nursing diagnosis for neonatal abstinence syndrome

Possible nursing diagnoses for clients with NAS

Ineffective infant feeding pattern related to hyperirritability, poor sucking reflex
Disturbed sleep pattern related to hyperexcitability and discomfort
Impaired comfort related to withdrawal symptoms
Risk for imbalanced nutrition: less than body requirements due to feeding difficulties
Delayed growth and development
Caregiver role strain

Nursing interventions

The first-line treatment of NAS is non-pharmacological. Nursing interventions include:

Keep the parent-infant dyad together through rooming-in.
Educate and involve parents in all aspects of infant care.
Encourage breastfeeding unless there is an absolute contraindication. Facilitate access to human donor milk, as needed.
Increase frequency of feeding and/or supplement with calorie-dense formula to meet increased energy requirement.
Facilitate frequent skin-to-skin contact, kangaroo care.
Reduce stimuli: Cluster care, dim lights, reduce noise.
Vertical rocking, side-lying C position, and swaddling may reduce irritability and hypertonicity.
Individualize interventions to infant’s symptoms/response.

If pharmacological options are used, treatment is aimed at improving withdrawal signs in the short-term and weaning as soon as NAS signs and symptoms are well controlled. There is no consensus regarding preferred agent, regimen, or weaning protocol.

Example nursing care plan for neonatal abstinence syndrome

Assessment: recognizing signs of NAS such as high-pitched crying, irritability, tremors, or seizures
Diagnoses (see above)
Plan actions to ensure adequate nutrition and hydration while alleviating withdrawal symptoms
Interventions (see above)
Evaluate the effectiveness of the interventions. Close interdisciplinary follow-up is necessary after discharge to meet the complex health needs of the parent-infant dyad and connect them to community resources.

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