A nurse is assessing a newborn who is experiencing neonatal abstinence syndrome. Which of the following findings should the nurse expect?

Neonatal abstinence syndrome (NAS) occurs when a newborn undergoes withdrawal from substances, most commonly opioids, to which they were exposed in utero. The central nervous system hyperexcitability that characterizes NAS produces tremors, irritability, high-pitched crying, and seizures. Tremors are one of the hallmark signs a nurse should expect during assessment of a newborn with NAS. Dry skin is not a classic feature of NAS; instead, infants may be diaphoretic due to autonomic instability. Bradypnea is incorrect because NAS typically causes tachypnea and increased respiratory rate as part of sympathetic nervous system stimulation. Hypotonia is also incorrect — NAS produces hypertonia and increased muscle tone, not decreased tone, because the withdrawal state results in heightened neuromuscular excitability. Other findings associated with NAS include poor feeding, vomiting, diarrhea, sneezing, yawning, temperature instability, and sleep disturbances. Recognizing tremors and other signs of CNS excitability allows the nurse to intervene appropriately, initiate the Finnegan Neonatal Abstinence Scoring Tool, and support the newborn through withdrawal with non-pharmacological comfort measures such as swaddling, minimizing stimulation, and promoting breastfeeding when appropriate.