A 20-year-old gravida 2, para 0, aborta 1 woman, dependent on heroin for the past 1.5 years, is referred to our tertiary care hospital. She is receiving maintenance methadone treatment (10 mg), which had been tapered (from 20 mg) at 22 weeks’ gestation; she continued on this regimen throughout pregnancy with adequate compliance. At 40 weeks’ gestation, she delivers a female infant vaginally, weighing 3.1 kg with no adverse intrapartum events. The Apgar scores are 9 and 9 at 1 and 5 minutes, respectively. With a background of maternal methadone therapy, the infant is nursed in a quiet environment, swaddled with minimal stimulation, and initiated on full feedings ad libitum. At 6 hours of age, the infant exhibits increased wakefulness, tremors, and excessive sucking. On examination, the axillary temperature is 102.2°F (39°C); other vital parameters are normal. Her Moro reflex is exaggerated. The infant’s Finnegan score at 2, 6, and...

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