MDCalc

Modified Finnegan Neonatal Abstinence Score (NAS)

Stratifies severity of opioid withdrawal in newborns.

The NAS should be monitored over time; protocols for management based on scoring may differ by institution but some studies suggest monitoring every 3-4 hours. 

Central nervous system disturbances

Cry
Sleep
Moro reflex
Tremors
Increased muscle tone
Excoriation
e.g. chin, knees, elbows, toes, nose
Myoclonic jerks
Twitching/jerking of limbs
Generalized convulsions

Metabolism, vasomotor, and respiratory disturbances

Sweating
Hyperthermia
Frequent yawning
>3-4 times per scoring interval
Mottling
Nasal stuffiness
Sneezing
>3-4 times per scoring interval
Nasal flaring
Respiratory rate

Gastrointestinal disturbances

Excessive Sucking
Poor feeding
Infrequent/uncoordinated suck
Regurgitation
Projectile vomiting
Stools

Result:

Please fill out required fields.
Management

Protocols for management based on scoring may differ by institution, but one study (Kocherlakota 2014) suggests the following:

  • Start scoring within 24 hours of birth and monitor every 3-4 hours.

  • For two consecutive scores ≥12 or three consecutive scores ≥8, initiate pharmacologic treatment.

  • If neither of the above, continue to monitor scores at every 3-4 hour intervals.