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Key Features

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  • Onset of symptoms commonly begins in the first 48 hours but may be delayed as long as 8 days, depending on the timing of the mother's last fix and her predelivery medication

  • Left untreated, mortality rate may be as high as 45%

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Clinical Findings

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  • Usually small for gestational age

  • Demonstrates yawning, sneezing, decreased Moro reflex, hunger but uncoordinated sucking action, jitteriness, tremor, constant movement, a shrill protracted cry, increased tendon reflexes, convulsions, vomiting, fever, watery diarrhea, cyanosis, dehydration, vasomotor instability, seizure, and collapse

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Diagnosis

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  • Can be confirmed easily by identifying the opioid in the urine of the mother and the newborn

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Treatment

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  • Phenobarbital (8 mg/kg/d intramuscularly or orally in four doses for 4 days and then reduced by one-third every 2 days as signs decrease) may be continued for as long as 3 weeks

  • Methadone may be necessary in infants with congenital methadone addiction who are not controlled in their withdrawal by large doses of phenobarbital

    • Dosage should be 0.5 mg/kg/d in two divided doses but can be increased gradually as needed

    • After control of the symptoms is achieved, the dose may be tapered over 4 weeks

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