A nurse is assessing a newborn whose mother has a history of substance abuse during pregnancy. Which assessment finding would be most indicative of neonatal abstinence syndrome (NAS)?

The hallmark of Neonatal Abstinence Syndrome (NAS) is CNS hyperirritability following the abrupt cessation of in-utero substance exposure. Key neurologic signs include a high-pitched cry, hyperactive reflexes, tremors, and an exaggerated Moro reflex. Gastrointestinal symptoms like poor feeding and diarrhea, and autonomic signs like tachypnea and fever, are also common.

Use a standardized scoring tool like the Finnegan Neonatal Abstinence Scoring System to assess severity every 3-4 hours. Non-pharmacologic care is first-line: provide a dark, quiet environment, gentle handling, and on-demand small, frequent feedings. Pharmacologic intervention with an opioid like morphine is indicated for consistently high scores.