Modified Finnegan Neonatal Abstinence Score (NAS)
Modified Finnegan NAS
CNS Disturbances
Cry
Sleep After Feeding
Moro Reflex
Tremors
Increased Muscle Tone
Excoriation (chin, knees, elbows, toes, nose)
Myoclonic Jerks
Generalized Seizures
Metabolic / Vasomotor / Respiratory
Sweating
Fever
Frequent Yawning (≥3-4 times)
Mottling
Nasal Stuffiness
Sneezing (≥3-4 times)
Nasal Flaring
Respiratory Rate
GI Disturbances
Excessive Sucking
Poor Feeding
Regurgitation / Projectile Vomiting
Stools
Score:–
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Stratifies severity of opioid withdrawal in newborns.
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.
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
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.