Neonatal Withdrawal Syndrome

Neonatal Withdrawal Syndrome

Introduction for Nursing Diagnosis: Neonatal Withdrawal Syndrome

Neonatal Withdrawal Syndrome (NWS) is a condition that occurs primarily in newborns who have been exposed to drugs, alcohol, or nicotine through their mother during pregnancy. NWS is caused by a disruption of the balance of certain chemicals in the baby’s brain and results in irritability, poor feeding and sucking, jitteriness, tremors, diarrhea, and eventually seizures.

NANDA Nursing Diagnosis Definition

Neonatal Withdrawal Syndrome: That state in which an infant has behavioral, autonomic, and physiological symptoms due to abrupt changes in the presence of drugs, alcohol, or nicotine which were ingested prenatally.

Defining Characteristics


  • Momentary disturbances in sleeping and eating patterns
  • Inadequate sucking strength or effort
  • Hyperirritability
  • Excessive crying
  • Frequent spasms
  • High-pitched cries


  • Mottled skin
  • Poor muscle tone
  • High pitched crying
  • Restlessness
  • Irregular breathing
  • Vomiting
  • Seizures
  • Fever
  • Sweating
  • Respiratory depression
  • Diarrhea

Related Factors

  • Exposure to drugs, alcohol, or nicotine prenatally

Risk Population

Infants born to mothers who abused drugs, alcohol, or nicotine while pregnant may be at risk for NWS.

Associated Problems

  • Poor feeding
  • Electrolyte imbalance
  • Complications of ventilation
  • Respiratory depression
  • Hyperthermia

Suggestions for Use

Neonatal Withdrawal Syndrome should be considered when assessing any newborn with severe irritability, poor feeding and sucking, tremors, jitteriness, or respiratory depression.

Suggested Alternative NANDA Diagnoses

  • Risk for Impaired Parenting
  • Ineffective Family Coping
  • Ineffective Infant Feeding Pattern
  • Impaired Gas Exchange
  • Readiness for Enhanced Fluid Balance
  • Readiness for Enhanced Safe Therapy Management
  • High Risk Infant

Usage Tips

  • Be aware of potential risk factors.
  • Study any known history and information provided by the mother.
  • Observe and record the presenting symptoms and associated behaviors.
  • Look for correlations between maternal drug use and neonatal withdrawal symptoms.
  • Monitor any peculiar behaviors or changes in breathing patterns.

NOC Results

  • Tissue Integrity: Skin and Mucous Membranes – infants with NWS can present with mottled skin, sweating, fever, and dehydration
  • Breathing Pattern – infants with NWS can experience irregular breathing, respiratory depression, and apnea
  • Hypothermia Risk, Risk for Fluid Volume Deficit, and Risk for Electrolyte Imbalance – infants with NWS are at risk for these complications due to issues with feeding and hydration
  • Security/Growth & Development – infants with NWS can experience excessive irritability and restlessness, which can interfere with normal development and growth.

NIC Interventions

  • Pain Management: Administer medications as needed to manage pain, such as acetaminophen or morphine.
  • Alteration in Comfort: Monitor vital signs and provide comfort measures.
  • Fluid/Electrolyte Management: Monitor electrolytes, administer supplemental fluids and electrolytes as needed.
  • Nutrition Management: Provide nutrition in accordance with physician’s orders.
  • Thermoregulation: Monitor temperature and provide insulation, cooling, or heating measures as needed.
  • Supportive Care: Monitor vital signs, assess neurologic status, provide emotional support, and monitor environment to ensure safety.
  • Assess Non-Pharmacologic Interventions: Utilize non-pharmacologic interventions, including swaddling, to reduce stimulating tactile sensations.


Nurses play an essential role in monitoring for and diagnosing Neonatal Withdrawal Syndrome in newborns. Proper assessment of risk factors, defining characteristics, and related problems is the first step in providing care and treatment to these infants. It is also important to remember that caregivers need education and support to properly care for the infants and prevent recurrence.


Q: Is Neonatal Withdrawal Syndrome preventable?
A: Exposure to drugs, alcohol or nicotine can be prevented by avoiding these substances while pregnant. While this is not always possible, it is recommended to reduce or eliminate exposure as much as possible.

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