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    • 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:

    Please fill out required fields.

    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.

    Formula

    Addition of the selected points:

    Variable

    Points

    Central nervous system disturbances

    Cry

    Normal

    0

    Excessive high-pitched cry <5 minutes

    2

    Continuous high-pitched cry >5 minutes

    3

    Sleep

    Normal

    0

    Sleeps <3 hours after feeding

    1

    Sleeps <2 hours after feeding

    2

    Sleeps <1 hour after feeding

    3

    Moro reflex

    Normal

    0

    Hyperactive

    2

    Markedly hyperactive

    3

    Tremors

    None

    0

    Mild tremors when disturbed

    1

    Moderate-severe tremors when disturbed

    2

    Mild tremors when undisturbed

    3

    Moderate-severe tremors when undisturbed

    4

    Increased muscle tone

    No

    0

    Yes

    1

    Excoriation (e.g. chin, knees, elbow, toes, nose)

    No

    0

    Yes

    1

    Myoclonic jerks (twitching/jerking of limbs)

    No

    0

    Yes

    3

    Generalized convulsions

    No

    0

    Yes

    5

    Metabolism, vasomotor, and respiratory disturbances

    Sweating

    No

    0

    Yes

    1

    Hyperthermia

    None

    0

    37.2-38.3ºC (99.0-100.9ºF)

    1

    >38.3ºC (>100.9ºF)

    2

    Frequent yawning (>3-4 times per scoring interval)

    No

    0

    Yes

    1

    Mottling

    No

    0

    Yes

    1

    Nasal stuffiness

    No

    0

    Yes

    1

    Sneezing (>3-4 times per scoring interval)

    No

    0

    Yes

    1

    Nasal flaring

    No

    0

    Yes

    2

    Respiratory rate

    Normal

    0

    >60 breaths/minute, no retractions

    1

    >60 breaths/minute with retractions

    2

    Gastrointestinal disturbances

    Excessive sucking

    No

    0

    Yes

    1

    Poor feeding (infrequent/uncoordinated suck)

    No

    0

    Yes

    2

    Regurgitation

    No

    0

    ≥2 times during/post feeding

    2

    Projectile vomiting

    No

    0

    Yes

    3

    Stools

    Normal

    0

    Loose (curds/seedy)

    2

    Watery (water ring on diaper around stool)

    3

     

     

    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

    About the Creator
    Dr. Loretta P. Finnegan