The nurse in the newborn nursery is watchful for neonatal abstinence syndrome in the newborn of a crack-addicted mother. What would be the manifestations of this syndrome? (Select all that apply.)

Choice A rationale Body tremors are a common neurobehavioral sign of Neonatal Abstinence Syndrome (NAS), reflecting generalized central nervous system (CNS) hyperirritability due to the absence of the maternally supplied opioid. These tremors often manifest as rhythmic, involuntary muscle contractions, exacerbated by external stimuli, and are indicative of the heightened state of arousal and dysregulated autonomic nervous system functioning characteristic of withdrawal. Choice D rationale Excessive sneezing is a manifestation of autonomic nervous system dysfunction and hyperreflexia characteristic of NAS. The withdrawal state often causes overreaction to normal environmental stimuli, including tactile and olfactory inputs. This hypersensitivity leads to symptoms like frequent sneezing, yawning, and nasal stuffiness (rhinorrhea), which are non-specific indicators of neurobehavioral stress and autonomic instability. Choice E rationale Hyperirritability, defined as an excessive response to stimuli or an inability to be comforted, is a cardinal sign of NAS. It reflects a state of CNS hypersensitivity where the neonate's threshold for stimulation is significantly lowered. The infant exhibits frantic, high-pitched crying, increased wakefulness, and an exaggerated Moro reflex, demonstrating the profound disruption in neurological regulation caused by drug withdrawal. Choice B rationale Drowsiness or lethargy is not a typical manifestation of the hyper-excitable state seen in opioid-related NAS; rather, the infant usually exhibits wakefulness and difficulty sleeping. Drowsiness or CNS depression would be more characteristic of maternal overdose, the immediate acute drug effect on the newborn before withdrawal begins, or withdrawal from CNS depressants like barbiturates or alcohol, but not the hyperactivity seen in classic NAS. Choice C rationale Excessive appetite is not a characteristic finding in NAS. Paradoxically, infants undergoing withdrawal often exhibit poor feeding and an uncoordinated sucking reflex, sometimes accompanied by vomiting and diarrhea (gastrointestinal hypermotility). This combination leads to failure to thrive and significant weight loss, necessitating supportive and pharmacological management to ensure adequate nutrition and hydration during the withdrawal period.