Babies Born After Opioid Exposure: Who Needs Medicine, How Much Weight They Lose, and What We Still Don't Know

What three 2026 studies (Donahue et al., Andersen et al., and Devlin et al.) tell families about neonatal opioid withdrawal

Some babies are born after being exposed to opioid medicines or drugs during pregnancy, and a few days later may show signs of withdrawal. Three new studies looked at which babies end up needing medicine, how much weight these babies lose in their first two weeks, and whether hospital care changed after new national advice was published. They show that every baby's path is different, that a gentle newborn examination may one day help hospitals plan, and that no single treatment or rule fits every baby.

Why this matters to families

When a mother takes opioids during pregnancy, whether a prescribed treatment such as methadone or buprenorphine or a non-prescribed drug, her baby is exposed too. After birth the baby no longer receives the drug and may go through withdrawal. Doctors call this neonatal opioid withdrawal syndrome, or NOWS. Babies can be irritable or stiff, have trouble feeding, or sleep poorly. Some have only mild signs, while others need medicine for days or weeks. For families, the uncertainty is often the hardest part: it is difficult to know how long the baby will stay in hospital, whether they will go home together, and what the future holds.

How care for these babies has changed over the years

Traditionally, care for withdrawal has relied on a scoring tool, with medicine started when scores cross a set line. At the same time, the number of families affected grew quickly. In the United States, the rate of opioid-related diagnoses in pregnancy rose from 3.5 to 8.2 for every 1000 delivery hospitalisations between 2010 and 2017, and the rate of babies with withdrawal rose from 4.0 to 7.3 for every 1000 birth hospitalisations, according to figures quoted in the studies [1]. In 2020, the American Academy of Pediatrics, the main US organisation of paediatricians, published advice for hospitals. As the studies describe it, the advice supported using a standard scoring tool to judge how a baby is doing, relying first on comfort measures such as holding, swaddling, skin-to-skin contact, a quiet room and breastfeeding when appropriate, and using medicine for severe signs that comfort measures do not control [2] [3].

Researchers also tested medicines, comparing methadone with morphine [4] and testing buprenorphine [5]. Another approach, called Eat, Sleep, Console, asks simple questions: can the baby eat, can the baby sleep, and can the baby be consoled within about ten minutes? It was compared with usual care in a research trial [6]. Having mothers and babies stay together in the same room has been linked to better family-centred care at lower cost [7]. Even so, doctors still could not predict early which baby would need medicine, and nobody knew whether the new advice had changed hospital stays.

What the three studies did

The first study, led by Donahue, followed babies at two hospitals, Women and Infants Hospital in Rhode Island and the University of Utah Hospital [8]. Trained examiners did a 15-minute newborn check in the first one to two days of life, before any withdrawal signs. The check looks at things such as how alert the baby is, how well the baby calms, muscle tone, reflexes and how smoothly the baby moves. A total of 217 mothers and babies joined, and 135 babies had the check early enough to be included in this analysis. The researchers then looked at who ended up needing medicine.

The second study, led by Andersen, used hospital and insurance records of 868 babies born between 2010 and 2021 at Vanderbilt University Medical Center in Tennessee [9]. These babies had all been exposed to opioids. It looked at how much weight each baby lost in the first 14 days and at what the mothers had taken before delivery.

The third study, led by Devlin, looked back at records from 13 US hospitals in a research network called HELP for NOWS [3]. Called INFORM NOW (Informing NOWS Research through Retrospective Observational Data Collection), it compared 183 babies cared for in late 2019, before the 2020 advice, with 267 babies cared for between mid-2021 and early 2022, after it.

What the studies found

In the first study, most babies (about two in three) showed a "typical" pattern on the newborn check. About one in five were "hyper-aroused", meaning very wound up, jumpy and stressed, and about one in seven (15%) were "hypo-aroused", meaning sleepy and floppy [8]. Babies with either of the unusual patterns were more likely to need medicine, the odds of needing medicine were higher once the researchers accounted for differences between hospitals, although without that adjustment the difference was small and uncertain. Babies who needed medicine were also more often exposed to other substances such as nicotine, marijuana and benzodiazepines (a type of anxiety or sedative medicine), were less often breastfed, and more often had a child-welfare agency involved with the family. Because only 37 babies needed medicine, the results are early and need to be repeated before hospitals could rely on them.

In the second study, babies lost some weight in the first days. The typical baby lost about 7% of birth weight, and about one in six had a day when weight was 10% or more below birth weight [9]. Babies whose mothers had been taking medicines for opioid use disorder, or who had other drugs on their tests, lost a little more, between about half and one extra percentage point on average. That is roughly 15 to 30 grams for a 3-kilogram baby. Babies with several exposures reached their lowest weight later, around day 3 instead of day 2. The good news is that, as a group, the babies were back above their birth weight by about day 12. Feeding and weight in opioid-exposed babies have also been studied by other groups [10], [11].

In the third study, the hospitals as a group saw no overall change after the 2020 advice. Babies were no more or less likely to receive medicine, and the length of medicine treatment and hospital stay were similar [3]. However, results differed by the medicine used. Babies given buprenorphine had shorter treatment (20% shorter) and shorter stays (16% shorter) after the advice, while babies given methadone had longer ones. Each of these groups came from just one hospital, so this does not prove one medicine is better.

What this means for your baby

If you are expecting a baby who may have been exposed to opioids, these studies suggest a few reassuring things. Not every baby needs medicine: in the first study 37 of 135 babies did, and in the third, 255 of 450 did. Your care team may be keeping an eye on feeding and weight because some babies lose a bit more in the first days, and a small extra loss does not mean something is wrong. Your presence matters: holding, skin-to-skin contact, quiet and breastfeeding when possible are the first things recommended for every baby with withdrawal [2].

It also helps to be honest with your care team about everything taken during pregnancy, including prescribed medicines, tobacco, cannabis and other drugs. Other studies have examined how using several substances together relates to withdrawal and its severity [12], [13], [14], and treatment teams use this information to plan care, not to judge. Medication for opioid use disorder during pregnancy has its own research comparing buprenorphine with methadone [15], and these studies are not a reason to stop a treatment that helps keep a mother well. Please talk to your obstetric and neonatal teams before changing anything.

Some practical questions you may wish to ask your baby's team include: How will you check how my baby is doing, and how often? What will you do first before using any medicine? Can I stay with my baby, hold my baby and breastfeed? How will you watch my baby's weight and feeding? And what support is there for me and my family, including help with recovery and with any contact from child-welfare services? Asking these questions is a sign of an engaged parent, and good teams welcome them. One of the studies found that the babies who needed medicine were more likely to have child-welfare agencies involved with the family (about 65% of treated babies versus 36% of those not treated), which is a reminder that support for parents is part of the baby's treatment and not an extra.

What researchers are working on next

The newborn examination in the first study is not yet a test that decides who gets medicine. The authors want to repeat it in larger groups and build it into a prediction model. Earlier work also linked newborn neurobehaviour to later medical and behavioural outcomes [16], and a separate study described neurobehavioural profiles in opioid-exposed and unexposed newborns [17]. For weight, scientists want to find the babies who are slow to regain birth weight so that feeding plans can be set early. For medicines, researchers say that more study is needed to understand how well buprenorphine works for withdrawal.

You can read more on our site about a trial of the Eat, Sleep, Console approach and about prenatal cannabis exposure.

The bottom line

Every baby with opioid exposure is different. Early signs of how a baby is coping may help doctors plan, early weight loss is common and usually recovers, and the 2020 national advice alone did not shorten hospital stays across the hospitals studied. The best-supported care remains close to parents, patient and gentle, with good feeding and honest, judgement-free conversations. The research is moving toward helping each baby get exactly the care they need, and no more.

References

  1. Hirai AH, Ko JY, Owens PL, et al. Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the US, 2010-2017. JAMA. 2021;325(2):146-155. doi:10.1001/jama.2020.24991 ↩
  2. Patrick SW, Barfield WD, Poindexter BB, et al. Neonatal Opioid Withdrawal Syndrome. Pediatrics. 2020;146(5):e2020029074. doi:10.1542/peds.2020-029074 ↩
  3. Devlin LA, Kraft WK, Babineau DC, et al. Temporal trends in outcomes for infants with neonatal opioid withdrawal managed with the Finnegan scoring tool: Insights from the INFORM NOW Study. J Perinatol. 2026. Published online April 16, 2026. doi:10.1038/s41372-026-02644-7 ↩
  4. Davis JM, Shenberger J, Terrin N, et al. Comparison of Safety and Efficacy of Methadone vs Morphine for Treatment of Neonatal Abstinence Syndrome: A Randomized Clinical Trial. JAMA Pediatr. 2018;172(8):741-748. doi:10.1001/jamapediatrics.2018.1307 ↩
  5. Kraft WK, Adeniyi-Jones SC, Chervoneva I, et al. Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome. N Engl J Med. 2017;376(24):2341-2348. doi:10.1056/NEJMoa1614835 ↩
  6. Young LW, Ounpraseuth ST, Merhar SL, et al. Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal. N Engl J Med. 2023;388(25):2326-2337. doi:10.1056/NEJMoa2214470 ↩
  7. Holmes AV, Atwood EC, Whalen B, et al. Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost. Pediatrics. 2016;137(6):e20152929. doi:10.1542/peds.2015-2929 ↩
  8. Donahue M, Heil MR, Camerota M, et al. Association between NNNS-II profiles and pharmacological treatment in infants with prenatal opioid exposure. J Perinatol. 2026;46(6):1092-1097. doi:10.1038/s41372-026-02628-7 ↩
  9. Andersen N, Wiese A, Gargurevich N, et al. Association of Polysubstance Exposure and Neonatal Weight Loss Among Infants Exposed to Opioids. J Pediatr Clin Pract. 2026;20:200210. doi:10.1016/j.jpedcp.2026.200210 ↩
  10. Cheng FY, Shabanova V, Berkwitt AK, Grossman MR. Early Weight Loss Percentile Curves and Feeding Practices in Opioid-Exposed Infants. Hosp Pediatr. 2022;12(10):857-866. doi:10.1542/hpeds.2021-006137 ↩
  11. Dryden C, Young D, Campbell N, Mactier H. Postnatal weight loss in substitute methadone-exposed infants: implications for the management of breast feeding. Arch Dis Child Fetal Neonatal Ed. 2012;97(3):F214-F216. doi:10.1136/adc.2009.178723 ↩
  12. Huybrechts KF, Bateman BT, Desai RJ, et al. Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: cohort study. BMJ. 2017;358:j3326. doi:10.1136/bmj.j3326 ↩
  13. Sanlorenzo LA, Cooper WO, Dudley JA, et al. Increased Severity of Neonatal Abstinence Syndrome Associated With Concomitant Antenatal Opioid and Benzodiazepine Exposure. Hosp Pediatr. 2019;9(8):569-575. doi:10.1542/hpeds.2018-0227 ↩
  14. Wouldes TA, Lester BM. Opioid, methamphetamine, and polysubstance use: perinatal outcomes for the mother and infant. Front Pediatr. 2023;11:1305508. doi:10.3389/fped.2023.1305508 ↩
  15. Suarez EA, Huybrechts KF, Straub L, et al. Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy. N Engl J Med. 2022;387(22):2033-2044. doi:10.1056/NEJMoa2203318 ↩
  16. Liu J, Bann C, Lester B, et al. Neonatal Neurobehavior Predicts Medical and Behavioral Outcome. Pediatrics. 2010;125(1):e90-e98. doi:10.1542/peds.2009-0204 ↩
  17. Merhar SL, Yolton K, DeMauro SB, et al. Neurobehavioral Profiles in Opioid-Exposed and Unexposed Neonates. J Pediatr. 2025;281:114527. doi:10.1016/j.jpeds.2025.114527 ↩