Symptoms of neonatal drug withdrawal consist of: W = wakefulness; I = irritability; T = tremulousness, temperature variation, tachypnea; H = hyeractivity, high-pitched persistent cry, hyperacusia, hyperreflexia, hypertonus; D = diarrhea, diaphoresis, disorganized suck; R = rub marks, respiratory distress, rhinorrhea; A = apneic attacks, autonomic dysfunction; W = weight loss or failure to gain weight; A = alkalosis (respiratory); L = lacrimation (Fig 1); also, hiccups, vomiting, stuffy nose, sneezing, yawning, photophobia, twitching, myoclonic jerks, opisthotonos, or seizures.
When these symptoms are seen in a newborn infant, the physician should consider a diagnosis of withdrawal from maternal drugs. Narcotics reported to cause these symptoms in the neonate are heroin,1 methadone,2 meperidine,3 morphine, codeine,4 pentazocine,5,6 and propoxyphene.7 A glossary of drugs is provided in Fig. 2.
The onset of symptoms may be present at birth or may begin within four days of delivery. In some instances, symptoms may not become obvious until 10 days of age. This depends upon the drug the infant was exposed to in utero and the pharmaco-kinetic excretion of the drug. Subacute symptoms of narcotic drug withdrawal may last for 4 to 6 months.8
Rosen and Pippenger9 have demonstrated that infants born to mothers maintained on methadone do not begin to manifest withdrawal symptoms until the plasma level is less than 0.06 µg/mL. In utero exposure to multiple drugs may cause a biphasic pattern of withdrawal symptomatology in the neonate.10 Polydrug abusers frequently use as many as two to five drugs in combination; these might include phenobarbital, diazepam, marijuana, pentazocine, tripelennamine, phencyclidine, and codeine.11 A physician who is unaware of a mother's drug ingestion may initially make an erroneous diagnosis of colic in the infant; therefore, a detailed maternal drug history should be obtained, including prescription and nonprescription drugs received, social habits of the parents, and whether the mother is breast-feeding.
Capsule Commentary on Faerber et al., Content Analysis of False and Misleading Claims in Television Advertising for Prescription and Nonprescription Drugs