CMAJ OPEN

Newborns exposed to opioids in utero often undergo opioid withdrawal shortly after birth.1,2 The associ-ated clinical findings primarily relate to the effects of opioid withdrawal on the central nervous system (e.g., tremors, irritability, increased crying, myoclonus and sei-zures), gastrointestinal tract (e.g., poor feeding, vomiting, diarrhea and consequent intravascular volume depletion) and the autonomic nervous system (e.g., diaphoresis, tempera-ture dysregulation and tachypnea). Collectively, these clini-cal findings are referred to as neonatal abstinence syndrome, a term that also applies to signs of withdrawal from other drugs such as antidepressants, benzodiazepines and alcohol.1 Infants born to mothers who misuse opioids are more likely to be premature, have low birth weight and have higher mortality.3,4 Neonatal opioid withdrawal often necessitates care in a neonatal intensive care unit (NICU), although a spectrum of severity exists, and the resulting mother–infan