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Updated: Dec 25 2021

Neonatal Abstinence Syndrome

  • Snapshot
    • A two-day old male infant presents with irritability, a high-pitched cry, poor oral intake, and loose stools. He was born at term to a 25-year-old mother with known heroin-use disorder. On exam, the infant is frequently yawing and sneezing. Tremors and hyperactive primitive reflexes are also noted.
  • Introduction
    • Mother with substance-abuse disorder may lead to acute withdrawal symptoms in the newborn
      • refered to as neonatal abstinence syndrome (NAS)
      • some causes of NAS
        • opioid exposure (most common)
        • nicotine
  • Epidemiology
    • Increased incidence of opioid pain reliever use in mothers
      • increases incidence of NAS
    • Pathogenesis
      • opioid withdrawal
        • in utero exposure to opioids due to their lipophilic property and small size
          • crosses placenta and blood-brain barrier
        • birth disrupts drug exposure → withdrawal
  • Presentation
    • Symptoms
      • irritability
      • poor feeding
      • high-pitched cry
    • Physical symptoms
      • sneezing
      • yawning
      • tremor
      • hyperactive reflexes
      • mottled skin
  • Differential
    • Neonatal hypoglycemia
    • Neonatal sepsis
    • Intracranial hemorrhage
    • Electrolyte disturbances
      • hypocalcemia
      • hypomagnesemia
    • Diagnosis primarily based on symptoms and history of in-utero drug exposure
  • Treatment
    • Prevention
      • avoid maternal opioid use
    • Supportive
      • reduce sensory stimulation
      • nutrition to prevent delayed growth
      • breast feeding
      • skin care
      • IV hydration and electrolyte replacement
    • Pharmacologic
      • opioids
        • based on symptom severity, and responsiveness to supportive treatment
  • Complications
    • Seizures
      • opioid withdrawal presents largest risk of seizure
    • Weight loss
  • Prognosis
    • Low long-term mortality rate
    • Adverse neurodevelopmental outcome
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