NASCEND

Fact! Infants exposed to highly lipophilic opioids, such as buprenorphine or methadone, can experience prolonged or delayed withdrawal symptoms that persist after they go home.
This means caregivers need more than discharge paperwork. They need to know what symptoms to expect, how long they might last, and when to reach out for support. Want to prepare your families for this
Make sure your care team is equipped to prepare families for this. Reach out to learn more about our training programs.

Did you know that the negative effects of ACEs can be mitigated?
Adverse childhood experiences (ACEs) carry real and documented risks for long-term physical, emotional, and developmental health. But the research is also clear that those outcomes are not inevitable.
One of the strongest protective factors is something that cannot be prescribed or measured on a scoring tool: the presence of a warm, consistent, and nurturing caregiver. For opioid-exposed infants who may already face early adversity, that caregiver relationship can quite literally change the trajectory of a child's life.
This is why supporting the caregiver is just as important as treating the infant. They are not separate parts of the care plan. They are the same one.

Myth! It's important to arrange prompt pediatric follow up to monitor growth and development and provide ongoing assessment for and education about late withdrawal symptoms.

Adverse childhood experiences (ACEs) have been tied to many child and adult health problems. Toxic stress associated with ACEs can actually change brain structure in areas that are crucial for functioning and succeeding in every day life. Do you know which 3 areas are affected? 🤔 Drop your guess in the comments.

Fact! Due to increased maternal blood volume and plasma, commonly used medications like insulin, Prozac, and MAT prescriptions require an increase in dosage.

Development of withdrawal is multi-factorial. Here are 5 things that influence how withdrawal develops in opioid-exposed infants:
💊 Type of drug
💉Polysubstance exposure
⏰Timing between last maternal drug ingestion and infant delivery
🤰Prematurity
🧬Genetics

Opioid exposure in pregnancy rarely comes alone. Many mothers also smoke, and ni****ne withdrawal in newborns is real, it starts early, and it can look a lot like opioid withdrawal.
For care teams, this creates both a challenge and an opportunity. Early stimulant withdrawal symptoms can actually lead to earlier recognition and treatment of withdrawal overall. But if the full substance history is not known, those same symptoms can be mistaken for opioid withdrawal and treated with opioids the infant does not need.
The goal is always to minimize exposure. Knowing every substance the infant was exposed to is what makes that possible.

Myth! If mom received her methadone dose 2 hours before delivery, baby may not show any signs of withdrawal for 48 to 72 hours postpartum. That is methadone's long half-life at work.
An asymptomatic newborn is not necessarily a safe newborn. Knowing when baby was last exposed is just as critical as knowing the type of drug.

Last week we shared that withdrawal timelines in opioid-exposed newborns are not one-size-fits-all. This week, here is the breakdown.
He**in and other short-acting opioids move fast, with symptoms often appearing within hours. Buprenorphine has a longer half-life, so onset is slower, usually 1 to 3 days. Methadone is uniquely complex. It stores in fetal fat tissue during pregnancy and releases gradually after birth, which means some infants may not show withdrawal symptoms until up to 28 days later.
That last one catches a lot of care teams off guard. An infant who looks fine at discharge may still be heading toward peak symptoms at home.
Knowing the exposure is not just good practice. It is what makes the rest of the care plan possible.

Did you know? Withdrawal in opioid-exposed newborns doesn't follow a single timeline — and that distinction can make a real difference in care.
The onset, peak, and duration of NAS/NOWS symptoms vary depending on what the infant was exposed to and for how long. Some timelines are much shorter. Others are far longer than many care teams expect — with symptoms that can continue well beyond the newborn period. An infant who looks stable in the first day or two may not have reached their peak yet. Without knowing what to watch for and when, critical windows can be missed.
Knowing mom's full substance history isn't just background — it's a clinical roadmap for your whole care team.
👉 Watch for our next post where we break down the timelines side by side, by substance.