What is neonatal abstinence syndrome, which exposures cause it, and the general treatment approach?

• A. NAS results from in utero exposure to alcohol
• B. NAS results from in utero exposure to stimulants
• C. NAS results from in utero exposure to opioids (and sometimes other substances); symptoms include tremors, irritability, feeding difficulties, high-pitched cry; management includes supportive care and, in more severe cases, pharmacologic treatment with opioids (e.g., morphine, methadone) with gradual taper
• D. NAS is managed with hydration alone

Answer: (C)

Neonatal abstinence syndrome is withdrawal that occurs in a newborn after birth when there has been in utero exposure to opioids. The fetus becomes dependent on opioids such as heroin, methadone, or buprenorphine, and abrupt removal after birth leads to withdrawal symptoms. Common signs include tremors, irritability, feeding difficulties, and a high-pitched cry.

Treatment starts with supportive care: create a calm, low-stimulation environment, swaddle the infant, provide small, frequent feeds, and monitor hydration and weight. If symptoms are moderate to severe, pharmacologic therapy with an opioid agonist (like morphine or methadone) is initiated and gradually tapered as the infant improves. In some cases, additional medications may be used, but the main approach is to comfort and stabilize the infant and then wean them off opioids. This condition is primarily linked to opioid exposure, and hydration alone does not address the withdrawal symptoms.