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Neonatal opioid withdrawal syndrome — RACP Paediatrics MCQ

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ModerateNeonatologyNeonatal opioid withdrawal syndromeRACP Paediatrics

A newborn is unsettled on day 3 with a high-pitched cry, tremor, sneezing, loose stools and poor sleep. His mother received opioid substitution therapy during pregnancy and there are no signs of infection. What is the most likely diagnosis?

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Correct answer: E — Neonatal opioid withdrawal syndrome

The combination of autonomic, gastrointestinal and neurological irritability after antenatal opioid exposure is typical of neonatal opioid withdrawal syndrome. Sepsis remains an important differential but does not explain the characteristic sneezing, tremor and diarrhoea pattern in this context. A useful pearl is that non-pharmacological care, rooming-in and feeding support are first-line, with opioid therapy for severe withdrawal.

Reference: Therapeutic Guidelines (eTG); RCH Clinical Practice Guidelines: Neonatal abstinence syndrome