An infant born at 35 weeks' gestation to a mother with no prenatal care is noted to be jittery and irritable, and is having difficulty feeding. You note coarse tremors on examination. The nurses report a high-pitched cry and note several episodes of diarrhea and emesis. You suspect which of the following?

Infants born to narcotic addicts are more likely than other children to exhibit a variety of problems, including perinatal complications, prematurity, and low birth weight. The onset of withdrawal commonly occurs during an infant's first 2 days of life and is characterized by hyperirritability and coarse tremors, along with vomiting, diarrhea, fever, high-pitched cry, and hyperventilation; seizures and respiratory depression are less common. The production of surfactant can be accelerated in the infant of a heroin-addicted mother.In utero exposure to alcohol leads to a fetal alcohol syndrome consisting of growth retardation, microcephaly, flat philtrum, thin upper lip, cardiac defects, and hypoplastic fifth fingernails. Maternal cocaine use puts the infant at risk for vascular accidents and premature delivery, but not a withdrawal syndrome. Similarly, marijuana is not associated with neonatal withdrawal. Maternal tobacco use can result in small-for-gestation age infants, but not a neonatal withdrawal syndrome as described in the question.