Inpatient Pathway for the Evaluation/Treatment of Infants with Neonatal Abstinence Syndrome

Maternal Non-narcotic Drugs that Cause Neonatal Psychomotor Behavior Consistent with Withdrawal

Drug Signs Onset of Signs Duration of Signs*
Alcohol Hyperactivity, crying, irritability, poor suck, tremors, seizures; onset of signs at birth, poor sleeping pattern, hyperphagia, diaphoresis 3-12 h 18 mo
Barbiturates Irritability, severe tremors, hyperacusis, excessive crying, vasomotor instability, diarrhea, restlessness, increased tone, hyperphagia, vomiting, disturbed sleep; onset first 24 h of life or as late as 10-14 d of age 1-14 d 4-6 mo with prescription
Caffeine Jitteriness, vomiting, bradycardia, tachypnea At birth 1-7 d
Chlordiazepoxide Irritability, tremors; signs may start at 21 d Days-weeks 9 mo; 11/2 mo with prescription
Clomipramine Hypothermia, cyanosis, tremors; onset 12 h of age   4 d with prescription
Diazepam Hypotonia, poor suck, hypothermia, apnea, hypertonia, hyperreflexia, tremors, vomiting, hyperactivity, tachypnea (mother receiving multiple drug therapy) Hours-weeks 8 mo; 10-66 d with prescription
Ethchlorvynol Lethargy, jitteriness, hyperphagia, irritability, poor suck, hypotonia (mother receiving multiple drug therapy)   Possibly 10 d with prescription
Glutethimide Increased tone, tremors, opisthotonos, high-pitched cry, hyperactivity, irritability, colic   6 mo
Hydroxyzine Tremors, irritability, hyperactivity, jitteriness, shrill cry, myoclonic jerks, hypotonia, increased respiratory and heart rates, feeding problems, clonic movements (mother receiving multiple drug therapy)   5 wk with prescription
Meprobamate Irritability, tremors, poor sleep patterns, abdominal pain 9 mo; 3 mo with prescription
SSRIs Crying, irritability, tremors, poor suck, feeding difficulty, hypertonia, tachypnea, sleep disturbance, hypoglycemia, seizures Hours-days 1-4 wk

* Prescription indicates the infant was treated with pharmacologic agents, and the natural course of the signs may have been shortened.

Hudak ML. Pediatr 2012;129:e540-e560