Opioid Withdrawal in Newborns

Key Features

• 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%

Clinical Findings

• 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

Diagnosis

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

Treatment

• 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