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 login to view 4 more bullets Epidemiology Increased incidence of opioid pain reliever use in mothers login to view 1 more bullet ETIOLOGY Pathogenesis login to view 4 more bullets Presentation Symptoms login to view 3 more bullets Physical symptoms login to view 5 more bullets Differential Neonatal hypoglycemia Neonatal sepsis Intracranial hemorrhage Electrolyte disturbances login to view 2 more bullets DIAGNOSIS Diagnosis primarily based on symptoms and history of in-utero drug exposure Treatment Prevention login to view 1 more bullet Supportive login to view 5 more bullets Pharmacologic login to view 2 more bullets Complications Seizures login to view 1 more bullet Weight loss Prognosis Low long-term mortality rate Adverse neurodevelopmental outcome