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methadone solution given by mouth or by feeding tube. Medical
evaluation and treatment of suspected NAS is critical, because
untreated NAS may lead to neonatal seizures or death. The duration of
treatment is days to months. An experienced physician and facility
safely and easily manage NAS.

The severity of withdrawal in the neonatal period does not impact IQ
scores later in life. Methadone exposed infants are within the normal
range of development and do not differ in cognitive function from
non-exposed infants matched for socio-demographic, biological and
health factors.

There is not a straightforward relationship between a pregnant
woman’s methadone dose and the baby’s risk of NAS. “Higher” doses
of methadone do not increase the risk of NAS but do increase the
likelihood of the mother achieving abstinence. The risk of NAS
appears to be related to the mother’s and the baby’s methadone blood
level at delivery and how quickly the baby’s blood level drops off in
the first 4 days of life. Babies appear to be at higher risk if the mother
and baby had a low methadone blood level or if the baby’s methadone
blood level drops quickly. In my clinical experience, withdrawal is
more likely if the pregnant woman is unstable, meaning she is using
drugs (heroin or other) in addition to methadone. However, there has
not been a study to evaluate the effects of non-opioid fetal drug
exposure on the expression of NAS. In addition maternal withdrawal
close to the time of delivery appears to increase the risk of neonatal
withdrawal. It has been postulated that a twice a day dosing schedule
which decreases the likelihood of maternal withdrawal may decrease
the risk of NAS.

In my clinical experience, it is not uncommon for a stable methadone
maintained woman with an average methadone dose (80-120 or
higher) to have a baby with no symptoms of NAS or very mild
symptoms, not progressing or requiring treatment. These babies are
able to go home with their mother at day of life 3 provided the mother
understands the necessity of bringing the baby in promptly should
symptoms of withdrawal occur.