What are common signs of Neonatal Opioid Withdrawal Syndrome (NOWS)?

Neonatal Opioid Withdrawal Syndrome (NOWS) is characterized by a range of signs that arise due to the infant's exposure to opioids during pregnancy. Common manifestations include alterations in muscle tone, such as either hypertonia or hypotonia, and autonomic disturbances, which can present as irritability, tremors, feeding difficulties, vomiting, diarrhea, and sweating.

Altered tone indicates a change in how the muscles respond to stimuli, which can be seen in infants as they may appear either excessively stiff or floppy. The autonomic disturbances refer to the effects on the autonomic nervous system, leading to symptoms like tachycardia, respiratory irregularities, and changes in blood pressure. These signs reflect the infant's struggle to adapt after birth when the opioid exposure is removed.

In contrast, signs such as excessive sleep and a calm demeanor, increased social engagement, normal feeding patterns, and heightened tolerance to stimuli are not characteristic of withdrawal. In fact, infants undergoing withdrawal typically exhibit increased irritability, a decrease in engagement, and sensory sensitivity rather than tolerance.

Recognizing these specific signs associated with NOWS is crucial for timely diagnosis and management, which may include supportive care and, in some cases, pharmacological interventions to alleviate withdrawal symptoms