Pathophysiology
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.