Which of the following is a clinical manifestation of neonatal abstinence syndrome?

High-pitched crying is a notable clinical manifestation of neonatal abstinence syndrome (NAS). Infants experiencing NAS may exhibit a range of symptoms as they withdraw from opioids or other substances their mothers may have used during pregnancy. This specific symptom is particularly characteristic of NAS and reflects the irritability and distress that these newborns often endure.

The high-pitched cry can be interpreted as a sign of discomfort and is frequently one of the initial indicators of withdrawal in a newborn. The cry is often distinct and more persistent than typical infant crying and can be associated with other withdrawal signs, such as tremors and hyperactive reflexes.

In contrast, the other options do not align with the typical manifestations of neonatal abstinence syndrome. For instance, decreased respiratory rate is generally not associated with NAS; in fact, affected infants may experience increased respiratory rates or periodic breathing difficulties. Excessive feeding is also uncommon as infants with NAS often demonstrate reduced feeding, reflecting their irritability and discomfort. Hypotonia, which refers to reduced muscle tone, is usually not a feature of NAS; rather, these infants tend to exhibit hypertonia or increased muscle tone. Thus, the presence of high-pitched crying serves as a clear and direct indicator of neonatal abstinence syndrome.