Synopsis
Assess newborn effects of prescribed medicines and substance exposure without stigma, distinguish toxicity from withdrawal and other illness, prioritise parent-infant supportive care, and use local neonatal pharmacotherapy safely when functional impairment persists.
- Use neonatal opioid withdrawal syndrome for opioid-specific withdrawal and neonatal abstinence syndrome when multiple drug classes may contribute; signs are clinical and nonspecific.
- Obtain a non-judgemental history of prescriptions, over-the-counter products, substitution therapy, alcohol, nicotine, recreational substances, timing, dose, route and last exposure.
- Opioid withdrawal commonly causes high-pitched cry, tremor, irritability, increased tone, poor sleep, yawning, sneezing, sweating, loose stool, vomiting and disorganised feeding.
Key red flags
Apnoea, bradycardia, cyanosis or marked sedation soon after birth suggests drug effect, respiratory disease, infection or HIE rather than withdrawal alone.
Investigation priorities
Establish whether the baby can feed, sleep, be consoled and maintain physiological stability.
Management branches
A medicine or substance with possible newborn effects is identified antenatally.
- Obtain specialist risk assessment without abrupt maternal cessation.
- Agree birth-site, observation, feeding, breastfeeding, maternal analgesia and safeguarding plans.
The baby is stable but at risk of adaptation or withdrawal.
Key medicines
Morphine sulfate oral solutionOne current NHS Greater Glasgow and Clyde neonatal protocol starts 60 micrograms/kg orally every 4 hours for significant opioid withdrawal, increasing by 10 micrograms/kg per dose daily to a maximum 80 micrograms/kg every 4 hours before specialist review and later gradual weaning. Other UK units use different schedules.
Phenobarbital oral or intravenousUse only the exact neonatal loading, maintenance and level-monitoring regimen in the treating unit's formulary when specialist review identifies refractory symptoms or important non-opioid or polysubstance withdrawal.