Poly-substance use may be more the rule for women with an opioid-use disorder, with two notable exceptions: (a) women who are in long-term recovery and receiving medication-assisted treatment (who become pregnant after beginning treatment), and (b) women whose opioid use was limited to prescribed opioids taken under medical supervision for pain management. The severity and duration of the withdrawal symptoms can be influenced by exposure to other substances, including tobacco and barbiturates. Those exposed to methadone or buprenorphine, which are longer acting opioids, will often present symptoms later than 72 hours, but usually within the first 4 days. The onset of the symptoms varies however, infants exposed to heroin or other short-acting opioids will typically show symptoms within the first 48–72 hours after birth.

Opioid withdrawal in a newborn causes central nervous system excitability or hyperirritability, such as tremors, stiff or rigid muscle tone, and vasomotor signs, as well as gastrointestinal signs, including vomiting and loose stools. maternal taking of other substances, including cigarettes, cocaine, hypnotics sedatives, and/or barbiturates.timing of the mother’s most recent intake of opioid.There are many variables that impact if, how, and when an infant will experience withdrawal symptoms.

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