What signs indicate neonatal withdrawal (NAS) due to maternal substances, and what is a typical pharmacologic management approach?

• A. Lethargy, poor feeding; management may include morphine or methadone with supportive care and gradual weaning.
• B. Cough, wheeze; treat with bronchodilators.
• C. Tremors, irritability, high-pitched cry, poor feeding; management may include morphine or methadone with supportive care and gradual weaning.
• D. Jaundice, poor feeding; treat with phototherapy.

Answer: (C)

Neonatal abstinence syndrome occurs when a newborn is exposed to opioids in utero and then goes through withdrawal after birth. The hallmark signs are CNS hyperarousal and feeding difficulties, which is why tremors, irritability, a high-pitched cry, and poor feeding fit NAS best. These symptoms reflect the baby’s nervous system waking up and becoming overactive after the absence of maternal opioids, along with feeding disruption from irritability and discomfort. In clinical practice, nurses monitor severity with a standardized scoring system (like the Finnegan score) to guide treatment.

Pharmacologic management typically uses opioid replacement therapy to stabilize withdrawal symptoms, with morphine or methadone being the common choices. The infant is titrated up to control withdrawal signs and then gradually tapered to wean off the opioid as the baby improves. Supportive care is essential: a quiet, low-stimulation environment, swaddling, small, frequent feeds, and careful monitoring of hydration and electrolytes. The other symptom patterns—cough and wheeze, jaundice with phototherapy, or lethargy with poor feeding—point to different conditions (respiratory issues, hyperbilirubinemia, or non-opioid causes) and don’t align as closely with NAS.