# A newborn is delivered to a 28-year-old mother enrolled in a methadone maintenance program throughout pregnancy. At delivery the newborn has poor respiratory effort, heart rate 90, weak tone, and central cyanosis. Which intervention is most appropriate?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375180&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PA

## Question

A newborn is delivered to a 28-year-old mother enrolled in a methadone maintenance program throughout pregnancy. At delivery the newborn has poor respiratory effort, heart rate 90, weak tone, and central cyanosis. Which intervention is most appropriate?

## Option

1. Administer naloxone 0.1 mg/kg intramuscularly; this is the recommended dose for opioid-induced respiratory depression in newborns and will promptly reverse the opioid effects to restore spontaneous breathing without significant adverse effects. Provide supportive care after naloxone, but naloxone remains the priority to reverse respiratory depression from methadone.
2. Administer naloxone 0.05 mg/kg via the umbilical vein; using a reduced dose and the slower venous route minimizes the risk of precipitating withdrawal while still reversing respiratory depression. Continue to monitor the newborn and provide supportive care, but the modified naloxone approach is safe for infants of methadone-dependent mothers.
3. Avoid naloxone in this newborn; provide warmth, dry, stimulate, position, suction as needed, and initiate positive pressure ventilation per Neonatal Resuscitation Program (NRP) guidelines because naloxone is contraindicated in newborns of opioid-dependent mothers as it precipitates severe acute neonatal abstinence syndrome including seizures. **✔ Correct answer**
4. Provide supplemental oxygen via face mask and monitor the newborn in the nursery for respiratory depression; if no seizures occur, discharge after 24 hours with a follow-up appointment for outpatient methadone weaning because the respiratory depression from maternal methadone is typically transient and does not require naloxone administration.

**Correct answer: 3**

## Explanation

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.

## In-depth explanation

No naloxone in newborn of opioid-dependent mother — precipitates severe NAS and seizures. Resuscitate per NRP with warm-dry-stimulate-PPV.

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