NAS/NOWS, Neonatal — Non-Opioid Maternal Substances — Clinical Pathway: Inpatient Care

Neonatal Abstinence Syndrome (NAS) /Neonatal Opioid Withdrawal Syndrome (NOWS), Clinical Pathway, Inpatient

Non-Opioid Maternal Substances That Cause Withdrawal-Like Symptoms

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 hours
  • 18 months
Barbiturates
  • Irritability, severe tremors, hyperacusis, excessive crying, vasomotor instability, diarrhea, restlessness, increased tone, hyperphagia, vomiting, disturbed sleep; onset first 24 hours of life or as late as 10-14 days of age
  • 1 - 14 days
  • 4 - 6 months with prescription
Caffeine
  • Jitteriness, vomiting, bradycardia, tachypnea
  • At birth
  • 1 - 7 days
Chlordiazepoxide (Librium)
  • Irritability, tremors; signs may start at 21 days
  • Days-weeks
  • 9 months;
    11 - 12 months with prescription
Clomipramine (Anafranil)
  • Hypothermia, cyanosis, tremors; onset 12 hours of age
  • 4 days with prescription
  •  
Diazepam (Valium)
  • Hypotonia, poor suck, hypothermia, apnea, hypertonia, hyperreflexia, tremors, vomiting, hyperactivity, tachypnea (mother receiving multiple drug therapy)
  • Hours-weeks
  • 8 months; 10 - 66 days with prescription
Ethchlorvynol (Placidyl)
  • Lethargy, jitteriness, hyperphagia, irritability, poor suck, hypotonia (mother receiving multiple drug therapy)
  •  
  • Possibly 10 days with prescription
Hydroxyzine (Atarax, Equanil)
  • Tremors, irritability, hyperactivity, jitteriness, shrill cry, myoclonic jerks, hypotonia, increased respiratory and heart rates, feeding problems, clonic movements (mother receiving multiple drug therapy)
  •  
  • 5 weeks with prescription
Marijuana
  • Low birth weight, increased trembling, high pitched cry
  • At birth
  • Years
Meprobamate (Miltown, Equanil)
  • Irritability, tremors, poor sleep patterns, abdominal pain
  •  
  • 9 months;
    3 months with prescription
Nicotine (Tobacco products and e-cigarettes)
  • Low birth weight, irritability, resembles withdraw from other drugs, increased risk of SIDS
  • 24 - 48 hours
  • 5 days, some data on 10 - 27 days
SSRIs (e.g. Celexa, Lexapro, Prozac, Luvox, Paxil, Zoloft)
  • Crying, irritability, tremors, poor suck, feeding difficulty, hypertonia, tachypnea, sleep disturbance, hypoglycemia, seizures
  • Hours-days
  • 1 - 4 weeks
Stimulants (Cocaine, Methamphetamines)
  • Low birth weight, small head circumferences, irritability, hyperactivity, tremors, high-pitched cry, excessive suck
  • Birth to 72 hours
  • 5 - 7 days
*Prescription indicates the infant was treated with pharmacologic agents, and the natural course of the signs may
have been shortened. Hudak ML. Pediatrics 2012;129:e540-e560