Neonatal Abstinence Syndrome

Neonatal abstinence syndrome is withdrawal in a newborn who was exposed to a substance before birth, most often opioids, and whose supply suddenly stops at delivery. Think of a nervous system turned up too high: a shrill, high-pitched cry, tremors, hypertonia, an exaggerated Moro reflex, frantic but poorly coordinated sucking, vomiting, loose stools, sneezing, yawning, sweating, and tachypnea. Signs usually start one to three days after birth. Heroin tends to show up early, while long-acting methadone and buprenorphine show up later, so those newborns are observed for five to seven days. The nurse scores the newborn regularly with the Finnegan tool or Eat, Sleep, Console, and comfort care always comes first: swaddling, a dim and quiet room, skin-to-skin contact, rooming-in with the parent, a pacifier, and small, frequent feedings. If withdrawal stays severe, the newborn gets an opioid such as morphine, tapered slowly. Never give naloxone to these newborns, because it can trigger seizures. Breastfeeding is encouraged when the parent is stable in treatment, and care for the family stays nonjudgmental.