Unusual Case of Neonatal Opioid Withdrawal Syndrome Presenting as Status Epilepticus: Case Report

Abstract

The rising rates of substance misuse have resulted in the upsurge of neonatal abstinence syndrome (NAS) worldwide, including India. Neonatal opioid withdrawal syndrome (NOWS) is a subset of NAS resulting from chronic in-utero exposure to opioids. Diagnosing NOWS can be particularly difficult because its symptoms can be vague, and mothers may intentionally withhold information about their drug use. Till now, only a limited number of cases of NOWS have been reported from India. We present a case of NOWS presenting as status epilepticus. There was no history of maternal substance misuse on initial enquiry, and the baby was being managed as a case of idiopathic neonatal seizures. It was only after being informed by the mother’s psychiatrist that she had a history of opioid misuse and was non-compliant with maintenance medications that the probable diagnosis of NOWS could be made. Seizures were managed with phenobarbitone and phenytoin. The baby was discharged on a maintenance dose of phenobarbitone. Due to the rising incidence of substance misuse in our country, a high index of suspicion should be kept for the diagnosis of NAS or NOWS in neonates with unexplained neurological symptoms in the first few days of life.