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Protocol - Neonatal Abstinence Syndrome (NAS) and Neonatal Opioid Withdrawal Syndrome (NOWS)

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Description:

The Finnegan Neonatal Abstinence Score Tool (FNAST) 2019 Final is 31-line score sheet measuring 21 symptoms that are frequently observed in opiate-exposed infants. These are measured by presence/abstinence or severity at various time intervals.

Specific Instructions:

The neonatal abstinence syndrome scoring system was designed for term babies on 4-hourly feeds and may therefore need modification for preterm infants. In a term infant, scoring should be performed 30 minutes to 1 hour after a feed, before the baby falls asleep. If necessary, the infant should be awakened to elicit reflexes and behavior, but if the infant is woken to be scored, then diminished sleep after scoring should not be recorded. A crying infant should be soothed and quietened before assessing muscle tone, Moro reflex, and respiratory rate.

The 2010 Modified Neonatal Abstinence Syndrome Tool by Dr. Karen D'Apolito is a manual for instructions for evaluators that can be purchased for $120.00 for the cost of printing and mailing.

Protocol:

Finnegan Neonatal Abstinence Scoring Toll (FNAST)

Patient ID:                Name:                 Today’s Weight:                 DOB:                 Date:

Signs and Symptoms

Score

AM

PM

Comments

Central Nervous System Disturbances

Crying: Excessive High Pitched

2

 

 

 

 

 

 

 

 

 

 

 

 

 

Crying: Cont. High Pitched

3

 

 

 

 

 

 

 

 

 

 

 

 

 

Sleep < 1 Hr After Feeding

3

 

 

 

 

 

 

 

 

 

 

 

 

 

Sleep < 2 Hr After Feeding

2

 

 

 

 

 

 

 

 

 

 

 

 

 

Sleep < 3 Hr After Feeding

1

 

 

 

 

 

 

 

 

 

 

 

 

 

Hyperactive Moro reflex

2

 

 

 

 

 

 

 

 

 

 

 

 

 

Markedly Hyperactive Moro reflex

3

 

 

 

 

 

 

 

 

 

 

 

 

 

Mild Tremors: Disturbed

1

 

 

 

 

 

 

 

 

 

 

 

 

 

Mod-Severe Tremors: Disturbed

2

 

 

 

 

 

 

 

 

 

 

 

 

 

Mild Tremors: Undisturbed

3

 

 

 

 

 

 

 

 

 

 

 

 

 

Mod-Severe Tremors: Undisturbed

4

 

 

 

 

 

 

 

 

 

 

 

 

 

Increased muscle tone

2

 

 

 

 

 

 

 

 

 

 

 

 

 

Excoriation (Specific Area)

1

 

 

 

 

 

 

 

 

 

 

 

 

 

Myoclonic jerk

3

 

 

 

 

 

 

 

 

 

 

 

 

 

Generalized convulsions

5

 

 

 

 

 

 

 

 

 

 

 

 

 

Metabolic, Vasomotor And Respiratory Disturbance

Sweating

1

 

 

 

 

 

 

 

 

 

 

 

 

 

Fever < 101 (37.2-38.3C)

1

 

 

 

 

 

 

 

 

 

 

 

 

 

Fever > 101 (38.4C)

2

 

 

 

 

 

 

 

 

 

 

 

 

 

Frequent yawning (> 3)

1

 

 

 

 

 

 

 

 

 

 

 

 

 

Mottling

1

 

 

 

 

 

 

 

 

 

 

 

 

 

Nasal stuffiness

1

 

 

 

 

 

 

 

 

 

 

 

 

 

Sneezing (> 3)

1

 

 

 

 

 

 

 

 

 

 

 

 

 

Nasal flaring

2

 

 

 

 

 

 

 

 

 

 

 

 

 

Respiratory rate (> 60/min)

1

 

 

 

 

 

 

 

 

 

 

 

 

 

Respiratory rate (> 60/min with retractions)

2

 

 

 

 

 

 

 

 

 

 

 

 

 

Gastrointestinal Disturbances

Excessive sucking

1

 

 

 

 

 

 

 

 

 

 

 

 

 

Poor feeding

2

 

 

 

 

 

 

 

 

 

 

 

 

 

Regurgitation

2

 

 

 

 

 

 

 

 

 

 

 

 

 

Projectile vomiting

3

 

 

 

 

 

 

 

 

 

 

 

 

 

Loose stools

2

 

 

 

 

 

 

 

 

 

 

 

 

 

Watery stools

3

 

 

 

 

 

 

 

 

 

 

 

 

 

Score

Total Score

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Average Daily Score

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Inter-Observer Reliability %

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initials of Scorer 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initials of Scorer 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The FINNEGAN NEONATAL ABSTINENCE SCORE TOOL (FNAST) is for the assessment of infants exposed in utero to psychoactive drugs, particularly opioids/opiates. The evaluator should check signs observed at various time intervals and add the scores to obtain a total score. Observation of the scores over the time interval provides the progression/diminution of signs and the need for pharmacotherapy. Copyright, 2007.

The evaluator needs to be trained to administer the score and inter-rater reliability needs to assessed intermittently.

Protocol Name from Source:

Finnegan Neonatal Abstinence Score Tool (FNAST) 2019 Final

Availability:

Publicly available

Personnel and Training Required

Clinically trained staff

Equipment Needs

Thermometer and stopwatch/clock with a second hand

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training Yes
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Clinical Examination

Life Stage:

Infant

Participants:

Hospitalized full-term newborns

Selection Rationale

This protocol was selected for its shorter implementation time and the fact that it is used extensively in clinical settings.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Pediatric Finnegan Neonatal Abstinence Score Tool (FNAST) Assessment Score   7051599 CDE Browser
Derived Variables

None

Process and Review

Not applicable

Source

D’Apolito, K., & Finnegan, L. (2010). Assessing signs and symptoms of neonatal abstinence using the Finnegan Scoring Tool: An inter-observer reliability program. Neo Advances. http://www.neoadvances.com

Finnegan, L. P., Connaughton, J. F., Jr., Kron, R. E., & Emich, J. P.(1975). Neonatal abstinence syndrome: Assessment and management. Addictive Diseases, 2(1–2), 141–158.

General References

Finnegan, L. P. (1990). Neonatal abstinence syndrome: Assessment and pharmacotherapy. In N. Nelson (Ed.), Current therapy in neonatal-perinatal medicine (2nd ed, p. 317). Ontario, Canada: B. C. Decker.

Finnegan, L. P., & Kaltenbach, K. (1992). Neonatal abstinence syndrome. In R. A. Hoekelman, S. B. Friedman, N. Nelson, & H. M. Seidel (Eds.), Primary pediatric care (2nd ed., pp. 1367–1378.). St Louis, MO: C. V. Mosby.

Hudak, M. L., Tan, R. C., AAP Committee on Drugs, & AAP Committee on Fetus and Newborn. (2012). Neonatal drug withdrawal. Pediatrics, 129(2), e540–560.

Jansson, L. M., Velez, M., & Harrow, C. (2009). The opioid-exposed newborn: Assessment and pharmacologic management. Journal of Opioid Management, 5(1), 47–55.

Lester, B. M., Tronick, E. Z., & Brazelton, T. B. (2004). The Neonatal Intensive Care Unit Network Neurobehavioral Scale procedures. Pediatrics, 113(3 Pt. 2), 641–667.  

Royal Women’s Hospital Drug Information Centre, Newborn Emergency Transport Service (Victoria). (2004). Neonatal handbook. Carlton, Victoria, Australia: Author.

Sanlorenzo, L. A., Start, A. R., & Patrick, S. W. (2018). Neonatal Abstinence Syndrome: An update. Current Opinions in Pediatrics, 30(2), 182–186.

Wachman, E. M., Schiff, D. M., & Silverstein, M. (2018). Neonatal Abstinence Syndrome: Advances in diagnosis and treatment. JAMA, 319(13), 1362–1374.

Weiner, S. M., & Finnegan, L. P. (2015). Drug withdrawal in the neonate. In B. Carter & S. Gardner (Eds.), Mosby handbook of neonatal intensive care (8th ed.). Year Book, Inc.

Protocol ID:

300701

Variables:
Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
Pediatric Development
Measure Name:

Neonatal Abstinence Syndrome (NAS) and Neonatal Opioid Withdrawal Syndrome (NOWS)

Release Date:

December 11, 2019

Definition

The Finnegan Neonatal Abstinence Score Tool (FNAST) 2019 Final measures 21 symptoms that are frequently observed in newborn infants following in utero exposure to maternal medications and drugs of abuse.

Purpose

Observational assessment to check for signs of withdrawal in newborns.

Keywords

Finnegan Neonatal Abstinence Score Tool, FNAST, pediatric development, opiate exposure, dependence, withdrawal