Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

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    Modified Finnegan Neonatal Abstinence Score (NAS)

    Stratifies severity of opioid withdrawal in newborns.
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    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

    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.

    About the Creator
    Dr. Loretta P. Finnegan
    Are you Dr. Loretta P. Finnegan?