ToolsCalculators
Modified Finnegan Neonatal Abstinence Score (NAS)
Severity of opioid/drug withdrawal signs in the newborn.
Modified Finnegan Neonatal Abstinence Score (NAS)
Cry
Sleeps after feeding
Moro reflex
Tremors, disturbed
Tremors, undisturbed
Increased muscle tone
Excoriation (chin, knees, elbows)
Myoclonic jerks
Generalized convulsions
Sweating
Temperature
Frequent yawning (>3-4 times/interval)
Mottling
Nasal stuffiness
Frequent sneezing (>3-4 times/interval)
Nasal flaring
Respiratory rate
Excessive sucking
Poor feeding
Regurgitation
Projectile vomiting
Stools
Result0 points
Below the level at which pharmacotherapy is typically considered; continue supportive/non-pharmacologic care and scheduled reassessment.
- Total score
- 0
When to use
- Serial scoring (typically every 3-4 hours) of a newborn with suspected in-utero opioid/substance exposure to grade withdrawal severity and guide the decision to start or adjust pharmacotherapy.
Formula
Sum of points across 22 weighted CNS, metabolic/vasomotor/respiratory, and gastrointestinal signs, each scored 0 (absent) up to a maximum of 5 (generalized convulsions).
Pearls and pitfalls
- Inter-rater reliability is only moderate; structured training and eating/sleep-cycle-timed scoring improve consistency.
- Individual institutions vary in the exact score/number-of-consecutive-scores threshold used to trigger pharmacotherapy.