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Evaluation and analysis of the Modified Finnegan Scoring System for assessment of neonatal abstinence syndrome

Rafia Q. Baloch, MD, Jamie M. Pinto, MD, Patricia Greenberg, MS, Yen-Hong Kuo, PhD, Anita Siu, PharmD, BCPPS


Objective: The Finnegan Neonatal Abstinence Scoring System (FNASS) is the most commonly used scoring system for neonatal abstinence syndrome (NAS) both in its original and modified versions, despite challenges related to tool length and observer bias. The purpose of this study was to determine the most frequent symptoms of NAS that led to score elevation and prompted initiation of drug therapy on the Modified Finnegan (MF). We also sought to identify vital sign changes associated with score elevation.

Design: We conducted a retrospective study of neonates diagnosed with NAS, based on ICD-9 codes and charge data for methadone administration.

Setting: The study setting was in a Level III Neonatal Intensive Care Unit.

Patients, Participants: Ninety patients with a total of 286 MF scores recorded from 2011 to 2015 met inclusion criteria.

Main Outcome Measure(s): The primary outcome was overall occurrence for each specific component of the MF scoring tool during symptomatic periods. Secondary outcomes were vital sign changes.

Results: Among the MF elements, there were 13 components that were scored more often than others in symptomatic infants. Respiratory rate (RR) was elevated in infants with NAS, but other vital signs did not differ from age-specific norms.

Conclusions: Of the various signs of NAS used to score the MF, few are frequently observed. Our study reinforces literature that proposes a shortened MF assessment tool. Experimental research will be needed to determine the efficacy of a shortened MF tool for diagnosing NAS.


neonate, substance abuse, pregnancy

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