A newborn shows signs of neonatal abstinence syndrome. Which symptom cluster is most characteristic?

• A. Jitteriness, irritability, high-pitched cry, tremors, feeding difficulties
• B. Lethargy and poor feeding with decreased tremors
• C. Hypotension and bradycardia
• D. Rash and fever

Answer: (A)

Newborn withdrawal from opioids or other substances commonly presents with a pattern of CNS overactivity and autonomic arousal after birth. The most characteristic cluster includes jitteriness, irritability, a high-pitched cry, tremors, and feeding difficulties. Jitteriness and tremors reflect heightened CNS excitability, while irritability and a high-pitched cry signal a baby who cannot self-soothe. Feeding difficulties arise because the unsettled state makes coordinating sucking and swallowing tough, often leading to poor weight gain. In contrast, lethargy with decreased tremors suggests CNS depression rather than withdrawal; hypotension and bradycardia point to different etiologies such as sedation or medical instability; and rash with fever points to infection or another non-withdrawal process.