The treatment of drug-exposed neonates in the presence of potential withdrawal symptoms is an important issue in pediatric health. With the emergence of polydrug exposure, it is difficult to ascribe a drug consequence to a specific drug, and severity determines treatment within the first 24 to 48 hours of life. In addition, drug consequences often persist during the neonatal period and infancy, and may endure through school years. This retrospective study examined prevalence of CNS, ANS, and GI withdrawal symptoms at acute severity and treatment cessation with 126 neonates exposed to single drugs (heroin, methadone, or cocaine) and drug combinations of heroin, methadone, cocaine, and barbiturates. Groups were identified according to single drug and polydrug exposures and according to short-term and long-term treatment. Severity was compared for single drug and polydrug groups and short-term and long-term treatment groups according to treatment length, maximum DTO (diluted tincture of opium) treatment dose, days on maximum treatment dose, maximum Neonatal Abstinence Score (NASS), and methadone dose. Maternal and infant characteristics were compared according to single drug and polydrug exposure groups. Infant characteristics were also compared according to short-term and long-term treatment groups. Results indicated prominence of CNS withdrawal symptoms after treatment cessation and overall prominence of symptoms with polydrug exposure. Symptoms remaining after treatment were hypertonicity, excessive sucking, tremors, hyperactive Moro reflex, disturbed sleep, and sneezing. Regarding severity, treatment length was significantly longer for polydrug exposure when compared to single drug exposure. In particular, treatment days, maximum treatment dose, days on maximum dose, and maximum abstinence score were significantly higher for the long-term treatment group when compared to the short-term treatment group. These results imply that severity of withdrawal and polydrug exposure are important when examining drug-related effects in infants. The identified persisting symptoms expand the base of potential factors to be considered in follow-up studies for drug-exposed neonates. Patterns of dysfunction were discussed, including excessive sucking, hypertonicity, physical growth, deficits in state control, regulation of arousal and attention, and cognition.
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