Newborns of mothers on chronic opioid therapy (legitimate chronic pain, methadone or buprenorphine maintenance, opioid use disorder) develop physiologic dependence in utero. After delivery, sudden opioid withdrawal manifests as neonatal abstinence syndrome (NAS) — high-pitched cry, irritability, tremor, hypertonicity, poor feeding, sneezing, sweating, loose stools, fever, and possibly seizures — typically beginning hours to days after birth and managed with non-pharmacologic care, swaddling, and sometimes morphine or methadone tapers. Administering naloxone to such a newborn precipitates immediate severe withdrawal including seizures and is contraindicated; current Neonatal Resuscitation Program guidelines no longer recommend naloxone for resuscitation of any newborn at birth. The standard NRP approach is the airway-breathing-circulation algorithm: warm, dry, stimulate, position, suction if needed, and provide positive pressure ventilation if the newborn does not breathe spontaneously or has heart rate less than 100. Chest compressions if HR less than 60 despite adequate ventilation. Naloxone has no role and is harmful in this scenario. Discharging or giving subdose naloxone is wrong.
For study reference only. Always follow current clinical guidelines and your institution’s protocols.