Objective: To describe a rare case of neonatal abstinence syndrome from mother with HIV and Hepatitis C infection whose has been using methadone for 12 years.
Case: A three days old female infant was hospitalized with symptoms of high pitch cry, fever, tremor, poor feeding and vomiting. She was very irritable, sweating, and had highly fluctuating body temperature. She also found with high respiration rate, and hypoglycemia. The baby was born vigorous and appropriate for gestational age. Her mother is an HIV infected patient on regular ARV treatment. She has been using methadone for 12 years and an active smoker. 
At the baseline, we found Neonatal Abstinence Syndromes (NAS) score was 18 based on Finnegan Neonatal Abstinence Syndrome, HIV & Hepatitis C exposed infant. According to the guideline, oral morphine was given as a definitive medication together with other supportive therapy. After four days of therapy, morphine dose was tapered and continued until seventh days of treatment. Patient was discharged at day ninth of hozpitalization with no significant findings. 
Conclusion: Neonatal Abstinence Syndrome was found in a baby of mother with history of methadone using and HIV & Hepatitis C infection. NAS symptoms found when she was three days old. Morphine was given according to guideline until NAS score improved. Patient was discharged with good condition.