Supportive - swaddling to decrease sensory stimulation, frequent small feedings of 24 cal/oz formula
Opioids when supportive measures fail
Morphine is 1st line for infants exposed to both opioids and benzos
Neonatal morphine 0.4mg/ml PO sln
Watch for side effect limiting dose (urinary retention)
Withdrawal symptoms need to be stabilized for 3-5 days before taper
Mother's methadone < 50mg (or other opiate)
Start morphine PO sln 0.1mg/kg q3hrs with feeds
Increase by 0.1mg/kg hourly if<unk>  score ≥ 8, max 1mg/kg
Mother's methadone > 50mg
Start 0.2mg/kg q3hrs
Increase by 0.2mg/kg hourly if<unk>  score ≥ 8, max 1mg/kg
If NPO, use preservative free morphine at 50 mcg/ml
Load 30 mcg/kg over 1hr, then infusion at 2 mcg/kg/hr
Increase by 1 mcg/kg/hr hourly until<unk>  < 8, max 6 mcg/kg/hr
Longer acting buprenorphine may significantly reduce hospital admission and treatment duration as compared to morphine
Morphine q4 hours vs. buprenorphine q8 hours if<unk>  scale > 12
Buprenorphine dosed initially at 5 mcg/kg q8 hrs to max dose of 20 mcg/kg q8 hrs
Benzodiazepine withdrawal treatment
Midazolam 0.1mg/kg IV q3hrs or 0.3mg/kg PO q3hrs
OR phenobarbital 3mg/kg IV or PO q24hrs
Phenobarbital for seizures OR side effect limiting morphine effects OR max morphine dose reached
16mg/kg load divided into two consecutive feedings for day 1
24 hrs later, use 2-8mg/kg/day maintenance dose
Morphine is 1st line for infants exposed to both opioids and benzos
Neonatal morphine 0.4mg/ml PO sln
Watch for side effect limiting dose (urinary retention)
Withdrawal symptoms need to be stabilized for 3-5 days before taper
Mother's methadone < 50mg (or other opiate)
Start morphine PO sln 0.1mg/kg q3hrs with feeds
Increase by 0.1mg/kg hourly if<unk>  score ≥ 8, max 1mg/kg
Mother's methadone > 50mg
Start 0.2mg/kg q3hrs
Increase by 0.2mg/kg hourly if<unk>  score ≥ 8, max 1mg/kg
If NPO, use preservative free morphine at 50 mcg/ml
Load 30 mcg/kg over 1hr, then infusion at 2 mcg/kg/hr
Increase by 1 mcg/kg/hr hourly until<unk>  < 8, max 6 mcg/kg/hr
Neonatal morphine 0.4mg/ml PO sln
Watch for side effect limiting dose (urinary retention)
Withdrawal symptoms need to be stabilized for 3-5 days before taper
Mother's methadone < 50mg (or other opiate)
Start morphine PO sln 0.1mg/kg q3hrs with feeds
Increase by 0.1mg/kg hourly if<unk>  score ≥ 8, max 1mg/kg
Mother's methadone > 50mg
Start 0.2mg/kg q3hrs
Increase by 0.2mg/kg hourly if<unk>  score ≥ 8, max 1mg/kg
Watch for side effect limiting dose (urinary retention)
Withdrawal symptoms need to be stabilized for 3-5 days before taper
Start morphine PO sln 0.1mg/kg q3hrs with feeds
Increase by 0.1mg/kg hourly if<unk>  score ≥ 8, max 1mg/kg
Start 0.2mg/kg q3hrs
Increase by 0.2mg/kg hourly if<unk>  score ≥ 8, max 1mg/kg
Load 30 mcg/kg over 1hr, then infusion at 2 mcg/kg/hr
Increase by 1 mcg/kg/hr hourly until<unk>  < 8, max 6 mcg/kg/hr
Morphine q4 hours vs. buprenorphine q8 hours if<unk>  scale > 12
Buprenorphine dosed initially at 5 mcg/kg q8 hrs to max dose of 20 mcg/kg q8 hrs
Midazolam 0.1mg/kg IV q3hrs or 0.3mg/kg PO q3hrs
OR phenobarbital 3mg/kg IV or PO q24hrs
16mg/kg load divided into two consecutive feedings for day 1
24 hrs later, use 2-8mg/kg/day maintenance dose
Neonatal abstinence syndrome
Neonatal sepsis
Neonatal hypoglycemia
Hyperthyroidism/hypothyroidism
Non-neonatal hypoglycemia 
Hypocalcemia
Traumatic asphyxia
Hypoglycemia