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Neonatal opioid withdrawal

INTRODUCTION

A newborn infant born to a mother addicted to opioids is at risk for drug withdrawal. At delivery, the discontinuation of opioids from the maternal circulation can lead to a constellation of withdrawal symptoms known as the neonatal abstinence syndrome (NAS) (table 1).

The term opioid refers to natural and synthetic substances with morphine-like activity. Opiate refers to a subclass of opioids consisting of alkaloid compounds extracted from opium, including morphine, codeine, heroin, and methadone.

The clinical manifestations and management of neonatal opioid withdrawal will be reviewed here. Opioid abuse during pregnancy and neonatal exposure to other drugs of abuse are reviewed separately.

(See "Smoking and pregnancy" and "Alcohol intake and pregnancy" and "Substance use in pregnancy" and "Infants of mothers with substance abuse".)

EPIDEMIOLOGY

In one study from California, the reported prevalence of maternal opioid drug use at the time of delivery was one percent [1]. In this study of 30,000 women in 1992, the prevalence rates based upon ethnicity were 2.5, 1.6, 1.3, and 1.1 in black, white, Asian, and Hispanic mothers, respectively.
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