A nurse is assessing a newborn who is 48 hours old and has a maternal history of methadone use during pregnancy.Which of the following manifestations should the nurse identify as an indication of neonatal abstinence syndrome?

Choice A rationaleExcessive high-pitched crying is a hallmark of neonatal abstinence syndrome due to central nervous system hyperactivity caused by withdrawal from maternal opioids, such as methadone.Choice B rationaleAcrocyanosis, peripheral cyanosis of extremities, is common in newborns but is not specific to neonatal abstinence syndrome. It relates to immature peripheral circulation rather than opioid withdrawal.Choice C rationaleRespiratory rate of 50/min is within the normal range for newborns (30–60 breaths/min). It does not specifically indicate neonatal abstinence syndrome, lacking scientific association.Choice D rationaleHyporeactivity contrasts the hyperactive symptoms seen in neonatal abstinence syndrome, such as tremors, crying, or increased muscle tone, and is scientifically inaccurate for this condition.