acute intoxication, and to assess the safety of the infant’s current home environment First-line treatment for infants with abstinence syndrome is supportive care and decreased stimulation Available pharmacotherapy is dependent on the class of drug the infant was exposed to in utero Infants that present with seizures respond well to anticonvulsant therapy, however, these infants should have a broad diagnostic evaluation for seizure etiology, including infection, metabolic derangements, and CNS hemorrhage CLINICAL PEARLS AND PITFALLS The age of presentation for infants with NAS can vary from several hours to several weeks after birth, depending on the exposed substance Naloxone administration to chronically opioid-exposed neonates is contraindicated as it may precipitate severe withdrawal and/or seizures Opioids Infants with opiate withdrawal may present with sleep–wake abnormalities, feeding difficulties, irritability, or weight loss In extreme cases, up to 10% of infants will also present with seizures Common opioid exposures during pregnancy may include morphine (and its derivatives), heroin, methadone, and buprenorphine Sixty percent to 80% of infants exposed to heroin or methadone will develop signs of NAS Higher doses of maternal methadone are more likely to result in NAS The onset of withdrawal is most often in the first to days after birth, although can present as late as weeks of age Pharmacotherapy for opioid withdrawal includes opiates (oral or intravenous morphine), barbiturates (phenobarbital), and benzodiazepines (diazepam) Opiate treatment can decrease the incidence of seizure, reduce time to regain birth weight, and decrease the incidence of treatment failure More recent reports using clonidine have been promising in the treatment of opioid withdrawal, although larger, more detailed pharmacokinetic studies are warranted Cocaine Cocaine use in pregnancy increases the risk of intrauterine demise, placental abruption, hypoxia–ischemia, and growth restriction of the developing fetus Early exposure may also be associated with congenital anomalies, though a distinct syndrome has not been described These children may have abnormalities in state regulation, autonomic regulation, and reflexes at to weeks postpartum,