Clinical meaning
Neonatal Abstinence Syndrome results from in utero opioid exposure causing upregulation of cAMP and noradrenergic pathways. After birth, removal of the opioid agonist leads to unopposed noradrenergic activity causing CNS excitability, autonomic dysfunction, and GI disturbance. Onset depends on the half-life of the maternal opioid (heroin: 24-48h, methadone: 48-72h, buprenorphine: 36-60h). The Finnegan Neonatal Abstinence Scoring System or Eat-Sleep-Console (ESC) model guides treatment.
Diagnosis & workup
Diagnostics & workup: - Order urine and meconium toxicology screen for substance confirmation - Apply Finnegan Neonatal Abstinence Scoring System or Eat-Sleep-Console (ESC) assessment - Order CBC, electrolytes, and glucose monitoring - Order thyroid function tests (rule out neonatal thyrotoxicosis as mimic) - Order infectious disease screening (hepatitis B/C, HIV: maternal substance use risk) - Order cranial ultrasound if seizures occur - Monitor weight daily (caloric losses from increased activity and poor feeding) - Order stool studies if persistent diarrhea