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Treating Neonatal Opioid Withdrawal Syndrome

Neonatal Opioid Withdrawal Syndrome (NOWS) is the presence of withdrawal symptoms in a newborn. 

Symptoms of NOWS include:

  • High-pitched or inconsolable crying.
  • Tremors or seizures.
  • Repeated awakening or difficulty sleeping.
  • Irritability and discomfort.
  • Tight muscle tone and hyperactive reflexes.
  • Excessive yawning, sneezing, and stuffy nose.

Babies who have had known opioid exposure and babies with NOWS must be observed in the hospital for a minimum of five to seven days after birth. If NOWS is present, two approaches to treatment may be used: nonpharmacological and pharmacological.

Nonpharmacological (without medication) Approach

If your baby’s NOWS is not severe, they may not need any medication to help manage symptoms. This medication-free approach uses a peaceful atmosphere and calming techniques to help in your baby’s recovery. These techniques include low-lighting, quiet rooms, comforting and calming actions, and skin-to-skin contact. Visitation is limited to you and your support person while your baby is in recovery.

Breastfeeding can be an important part of your baby’s recovery. In addition to providing skin-to-skin contact and bonding, your breast milk contains a small amount of opioids that can help your baby with NOWS symptoms. The opioids that are present in breastmilk will not cause any additional withdrawal symptoms should you choose to switch to or supplement with formula. 

Pharmacological (with medication) Approach

If your baby has more severe withdrawal symptoms and they are unable to be managed without medication, a pharmacological approach may be needed. In this case, your baby would be moved to a neonatal intensive care unit (NICU) under the care of a neonatologist—a specialist in newborn babies.

In the NICU, your baby would receive small doses of morphine to wean them off any substances that were present at birth. The average length of stay for newborns who need morphine is 17 days from birth to discharge. Every baby is different, so your baby’s stay may be shorter or longer.

The Parent Partnership Unit (PPU)

The Parent Partnership Unit (PPU) is an inpatient program at UPMC Magee-Womens Hospital for babies who may experience NOWS. The goal of the PPU is to provide your newborn with outstanding care while you get the support you need to develop as a parent and continue to manage your recovery from opioid use disorder. The program supports you, your baby, and your family by allowing you to help care for your baby as they are being observed for signs of NOWS. Please visit our PPU page for more information and eligibility guidelines.

Contact Us

For more information, please call 412-641-1211.