The onset of signs attributable to neonatal withdrawal from heroin may be which of the following?

• A. At birth or within 24 hours of birth
• B. 24 to 74 hours after birth
• C. 3 to 7 days after birth
• D. 5 to 10 days after birth

Answer: (A)

The main idea is that the timing of neonatal withdrawal symptoms from opioid exposure depends on how long the drug stays active in the infant after birth. Heroin is a short-acting opioid, so after the baby is born and placental drug delivery ends, withdrawal signs often begin quickly—often right at birth or within the first 24 hours. This rapid onset reflects the rapid decline of heroin’s effects in the neonate and the immediate removal of the maternal opioid source. By contrast, longer-acting opioids (like methadone) can delay onset, sometimes because the drug lingers in the infant’s system and continues to produce withdrawal symptoms over 24–72 hours or more. So, for heroin exposure, beginning at birth or within the first day fits the expected pattern of neonatal abstinence syndrome.