Neonatal Abstinence syndrome (NAS)

What is NAS?

Neonatal Abstinence Syndrome (NAS) occurs when a baby is exposed to drugs in the womb; therefore, the baby goes through withdrawal from the drug following birth.

Babies can experience withdrawal due to the mother taking prescribed narcotics or by abusing street drugs. Almost every drug, prescription or non-prescription, passes from the mother's bloodstream through the placenta to the fetus. Illicit substances and street drugs that cause dependence and addiction in the mother also cause addiction in the fetus. At birth, the baby's dependence on the substance continues, but since the drug is no longer available, the baby's central nervous system becomes overstimulated, causing withdrawal.

Why is NAS a concern?

When a mother uses illicit substances, she places her baby at risk for many serious health problems. A mother using drugs may be less likely to seek prenatal care, which can increase the risks for her and her baby. In addition, women who use drugs are more likely to use more than one type of drug, which can complicate the treatment. In addition to the specific difficulties of withdrawal after birth, problems in the baby may include, but are not limited to: Poor intrauterine growth, Premature birth, Birth defects and Seizures.

What are the symptoms of NAS?

Symptoms of NAS may vary depending on the type of substance used, the last time it was used, and whether the baby is full-term or premature. Symptoms of withdrawal may begin as early as 24 to 48 hours after birth, or as late as five to 10 days. The following are the most common symptoms of neonatal abstinence syndrome. However, each baby may experience symptoms differently. Symptoms of withdrawal in full-term babies may include: Tremors (trembling), Irritability (excessive crying), Sleep problems, High-pitched crying, Tight muscle tone, Hyperactive reflexes, Seizures, Yawning, Stuffy nose or sneezing, Poor feeding and suck, Vomiting, Diarrhea, Dehydration, Sweating and Fever or unstable temperature. The symptoms of NAS may resemble other conditions or medical problems.

How is NAS diagnosed?

An accurate report of the mother's drug usage is important, including the time of the last drug taken. A neonatal abstinence scoring system may be used to help diagnose and grade the severity of the withdrawal. Using the scoring system, points are assigned for certain signs and symptoms and the severity of each. This scoring may also help in planning treatment. Treatment for neonatal abstinence syndrome Specific treatment for NAS will be determined by a doctor. Babies suffering from withdrawal are irritable and often have a difficult time being comforted. Swaddling, or snugly wrapping the baby in a blanket, may help comfort the baby. Babies also may need extra calories because of their increased activity and may need a higher calorie formula. Intravenous (IV) fluids are sometimes needed if the baby becomes dehydrated or has severe vomiting or diarrhea. Some babies may need medications to treat severe withdrawal symptoms, such as seizures, and to help relieve the discomfort and problems of withdrawal. The treatment drug is usually in the same family of drugs as the substance the baby is withdrawing from. Once the signs of withdrawal are controlled, the dosage is gradually decreased to help wean the baby off the drug.

Can NAS be prevented?

NAS is a TOTALLY PREVENTABLE problem. However, it requires that a mother stop using drugs before pregnancy, or as soon as she learns she is pregnant.



Protect yourself from tickborne disease. Tick exposure can occur year-round, but ticks are most active during warmer months (April-September)

Before You Go Outdoors:

  • Know where to expect ticks. Ticks live in grassy, brushy, or wooded areas, or even on animals.
  • Treat clothing and gear with products containing 0.5% permethrin. Alternatively, you can buy permethrin- treated clothing and gear.
  • Use Environmental Protection Agency (EPA)-registered insect repellents. Always follow product instructions.

Do not use insect repellent on babies younger than 2 months old. Do not use products containing OLE or PMD on children under 3 years old.

After You Come Indoors:

  • Check your clothing for ticks.
  • Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on clothing after you come indoors. If the clothes require washing, hot water is recommended. Cold and medium temperature water will not kill ticks.
  • Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later.
  • Shower soon after being outdoors. Showering within two hours of coming indoors has been shown to reduce your risk of getting Lyme disease and may be effective in reducing the risk of other tickborne diseases.
  • Check your body for ticks after being outdoors. Conduct a full body check. Use a hand-held or full-length mirror to view all parts of your body. 

Check these parts of your body and your child’s body for ticks:

  • Under the arms
  • In and around the ears
  • Inside belly button 
  • Back of the knees
  • In and around the hair
  • Between the legs
  • Around the waist

Learn more at:


Make Sure Your Child is Protected - MMR Vaccine

Measles is a very contagious disease caused by a virus. It spreads through the air when an infected person coughs or sneezes. Measles starts with fever. Soon after, it causes a cough, runny nose, and red eyes. Then a rash of tiny, red spots breaks out. It starts at the head and spreads to the rest of the body. Cases are being reported to the Center for Disease Control (CDC) from California, Colorado, Connecticut, Illinois, New Jersey, New York, Texas and Washington.

Measles can be prevented with MMR vaccine. The vaccine protects against three diseases: measles, mumps, and rubella. CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults should also be up to date on their MMR vaccination.

The MMR vaccine is very safe and effective. Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.

Children may also get MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

Before the measles vaccination program started in 1963, an estimated 3 to 4 million people got measles each year in the United States. Of these, approximately 500,000 cases were reported each year to CDC; of these, 400 to 500 died, 48,000 were hospitalized, and 1,000 developed encephalitis (brain swelling) from measles. Since then, widespread use of measles vaccine has led to a greater than 99% reduction in measles cases compared with the pre-vaccine era. However, measles is still common in other countries. Unvaccinated people continue to get measles while abroad and bring the disease into the United States and spread it to others. Visit the CDC's website for more information on Measles Cases in 2019.


After Hours Emergency Protocol

The Noble County Health Department has an after-hours emergency answering service system.  This system gives the caller a prompt in the case of a public health emergency to leave a message in a specified mailbox. Any message left in this voice mailbox will cause the system to contact the Nurse on call, who within the required time-frame shall call in to retrieve the message and follow up as required based on the situation protocol. All calls received after normal working hours that are determined to be a public health emergency will be relayed to the Health Commissioner or Medical Director.  The phone number of the answering service system is the same as the health department and is available 24 hours a day at 740-732-4958.

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