Table 3.
Neonatal abstinence syndrome differential diagnosis
| Specific NAS Sign | Differential Diagnosis |
|---|---|
| Irritability | GE reflux |
| Pain/discomfort | |
| Sepsis | |
| Brain injury | |
| Fever | Sepsis (especially herpes simplex virus) |
| Hyperthyroidism | |
| Feeding problems | Oromotor dysfunction |
| Anomalies (eg, cleft palate, micrognathia, Pierre Robin sequence, genetic syndromes such as Prader Willi) | |
| Polycythemia | |
| Immaturity, including late preterm birth | |
| Brain injury | |
| Sepsis | |
| Jitteriness | Hypoglycemia |
| Hypocalcemia | |
| Immaturity | |
| Injury of the nervous system | |
| Myoclonic jerkinga | Not uncommon in opioid-exposed infants and can be mistaken for seizure activity |
| Seizures (rare in infants with NAS) | Hypocalcemia |
| Hypoglycemia | |
| Hypoxic-ischemic encephalopathy | |
| Brain hemorrhage/stroke | |
Abbreviation: GE, gastroesophageal.
a
Myoclonic jerks can be unilateral or bilateral, occur during sleep, and do not stop when the extremity or affected body part is held. They may be medication related. Electroencephalograms are not warranted in infants with myoclonic jerks. They generally do not respond to medications used to treat NAS.