There is a baby in the neonatal intensive care unit (NICU) who is exhibiting signs of neonatal abstinence syndrome. Which of the following medications are contraindicated for this neonate?

Choice A rationale

Deep sleep is not a characteristic of neonatal abstinence syndrome; rather, infants tend to exhibit irritability and disturbed sleep patterns due to central nervous system hyperirritability caused by opioid withdrawal.

Choice B rationale

A high-pitched cry occurs due to central nervous system overstimulation and hyperirritability, which are hallmark features of neonatal abstinence syndrome and a direct result of opioid withdrawal in neonates.

Choice C rationale

Poor feeding is common in neonatal abstinence syndrome due to uncoordinated suck reflexes and gastrointestinal disturbances, leading to difficulty maintaining adequate nutrition and hydration in affected neonates.

Choice D rationale

Neonates with neonatal abstinence syndrome often exhibit tremors or shaking as a result of central nervous system hyperirritability, which is a hallmark symptom of opioid withdrawal in newborns.

Choice E rationale

Excessive sweating is a manifestation of autonomic nervous system dysregulation caused by opioid withdrawal in neonates, commonly observed in infants with neonatal abstinence syndrome.

Choice A rationale

While conjunctival irritation could occur from exposure to irritants, it is not a primary concern in this case. Respiratory complications take precedence due to the risk of aspiration from meconium-stained fluid.

Choice B rationale

Rectal temperature assessment for hyperthermia is important but not critical in the immediate scenario. Respiratory distress monitoring is more urgent due to the association with meconium aspiration syndrome.

Choice C rationale

Bathing to remove meconium-stained fluid minimizes infection risk. However, respiratory assessment is more critical due to the severe pulmonary complications associated with meconium aspiration.

Choice D rationale

Meconium-stained amniotic fluid increases the risk of aspiration, leading to respiratory distress. Early respiratory evaluation prevents hypoxia, pulmonary hypertension, or pneumonitis, which are serious complications in neonates.