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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Modified Finnegan Neonatal Abstinence Score (NAS)

    Stratifies severity of opioid withdrawal in newborns.

    INSTRUCTIONS

    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. 

    When to Use

    Newborns in whom there is concern for neonatal abstinence syndrome (NAS); i.e., positive maternal drug abuse by history or urine toxicology.

    Central nervous system disturbances
    Normal
    0
    Excessive high-pitched cry <5 min
    +2
    Continuous high-pitched cry >5 min
    +3
    Normal
    0
    Sleeps <3 hrs after feeding
    +1
    Sleeps <2 hrs after feeding
    +2
    Sleeps <1 hour after feeding
    +3
    Normal
    0
    Hyperactive
    +2
    Markedly hyperactive
    +3
    None
    0
    Mild tremors when disturbed
    +1
    Moderate-severe tremors when disturbed
    +2
    Mild tremors when undisturbed
    +3
    Moderate-severe tremors when undisturbed
    +4
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +3
    No
    0
    Yes
    +5
    Metabolism, vasomotor, and respiratory disturbances
    No
    0
    Yes
    +1
    None
    0
    37.2-38.3ºC (99.0-100.9ºF)
    +1
    >38.3ºC (>100.9ºF)
    +2
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +2
    Normal
    0
    >60 breaths/minute, no retractions
    +1
    >60 breaths/minute with retractions
    +2
    Gastrointestinal disturbances
    No
    0
    Yes
    +1
    No
    0
    Yes
    +2
    No
    0
    ≥2 times during/post feeding
    +2
    No
    0
    Yes
    +3
    Normal
    0
    Loose (curds/seedy)
    +2
    Watery (water ring on diaper around stool)
    +3

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Loretta P. Finnegan

    About the Creator

    Loretta P. Finnegan, MD, is the executive officer of the College on Problems of Drug Dependence in Philadelphia, PA. She is also the president of Finnegan Consulting. Dr. Finnegan's primary research is focused on women's health and perinatal addiction.

    To view Dr. Loretta P. Finnegan's publications, visit PubMed

    Are you Dr. Loretta P. Finnegan? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    About the Creator
    Dr. Loretta P. Finnegan
    Are you Dr. Loretta P. Finnegan?