Neonatal Abstinence Syndrome (NAS) Finnegan Score

About Finnegan score

This is a scoring system to be used in the assessment of newborn patients who are suspected of neonatal abstinence syndrome (NAS).

It consists of 31 items which portray symptoms characteristic of NAS and offers an indication whether withdrawal is present or not and whether medication should be initiated.

If during gestation the fetus then infant is subject to drugs, after birth (which also marks the abrupt cessation of drug exposure), the infant is at risk of neonatal abstinence syndrome.

NAS is most commonly caused by exposure to sedatives, barbiturates and alcohol.

There is a different onset of withdrawal symptoms, usually depending on the substance the infant was exposed to:

■ Onset 3 to 12 hours after birth in alcohol exposure;

■ Onset within 24-36 hours up to 7 days in opioid exposure;

■ Onset within 1 to 3 days in sedative exposure.

The items in the Finnegan score and their associated weighting in the final score (in points) are provided below:

1) Central Nervous System (15 items):

■ Excessive high pitched (or other) cry (<5 min) [2];

■ Continuous high pitched (or other) cry (>5 min) [3];

■ Sleep <1 hour after feeding [3];

■ Sleep <2 hours after feeding [2];

■ Sleep <3 hours after feeding [1];

■ Hyperactive Moro reflex [2];

■ Moderately hyperactive Moro reflex [3];

■ 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 [1];

■ Excoriation (eg. Chin, knees, elbows, toes, nose) [1];

■ Myclonic jerks (twitching/jerking of limbs) [3];

■ Generalized convulsions [5].

2) Metabolism, Vasomotor, Respiratory (10 items):

■ Sweating [1];

■ Hyperthermia (37.2 –38.2°C) [1];

■ Hyperthermia (=38.4°C) [2];

■ Frequent yawning [1];

■ Molting [1];

■ Nasal stuffiness [1];

■ Frequent sneezing (>3-4/interval) [1];

■ Nasal flaring [2];

■ Respiratory rate >60/min [1];

■ Respiratory rate >60/min with retractions [2].

3) Gastrointestinal (6 items):

■ Excessive sucking [1];

■ Poor feeding (infrequent/uncoordinated suck) [2];

■ Regurgitation (=2 times during/past feed) [2];

■ Projectile vomiting [3];

■ Loose stool [2];

■ Watery stool [3].

The main limitation of the scale refers to its length and the fact that it requires a long assessment duration.

On the other hand, it is often referenced for its usability, especially because of how comprehensive it is.

Result interpretation

Each of the 31 items in the three categories of the Finnegan Neonatal Abstinence Scoring System has a specific weighting in the final score, which can vary from 1 point to 3 points.

Clinicians are recommended to apply the score every 4 hours during admission when the initial score was below 8 and then if it becomes greater than 8 (worsening of status) to apply the assessment every 2 hours.

Medication, meant to stabilize the more severely symptomatic infants, is to be instituted when 2 subsequent scorings have revealed scores greater than 8. This should only be temporary, until the withdrawal symptoms recede.

In case, some of the items in the score are deemed present because of other conditions than NAS, these should be excluded from the final score and treated separately.

Original source

Finnegan L. P., Connaughton J. F. Jr, Kron R. E., Emich J. P. Neonatal abstinence syndrome: assessment and manage-ment. Addict Dis. 1975;2: 141–58.

Other references

1. Zimmermann-Baer U, Nötzli U, Rentsch K, Bucher HU. Finnegan neonatal abstinence scoring system: normal values for first 3 days and weeks 5-6 in non-addicted infants. Addiction. 2010; 105(3):524-8.

2. Siu A, Robinson CA. Neonatal Abstinence Syndrome: Essentials for the Practitioner. J Pediatr Pharmacol Ther. 2014; 19(3): 147–155.