Neonatal Abstinence Syndrome

An opioid-exposed newborn may appear stable immediately after birth because placental drug delivery has not yet stopped. Once the cord is separated, the continuous opioid supply ends and physical dependence becomes visible as autonomic, neurologic, and gastrointestinal withdrawal. This is the physiologic basis of neonatal abstinence syndrome (NAS), also called neonatal opioid withdrawal syndrome (NOWS) when opioids are the exposure. The bedside question is not simply whether exposure occurred. It is whether withdrawal is disrupting feeding, sleep, consolability, growth, or physiologic stability. Begin with a low-stimulation environment and close caregiver contact, then use the unit's structured assessment pathway to decide whether medication is needed. A high score never replaces an airway, breathing, circulation, and temperature assessment. Tremors, irritability, sneezing, loose stools, and poor feeding may fit withdrawal. Respiratory depression, seizures, marked temperature instability, or poor perfusion signal possible deterioration and require immediate neonatal resuscitation rather than routine NAS scoring.