Inpatient Pathway for the Evaluation/Treatment of Infants with Neonatal Abstinence Syndrome

Finnegan Neonatal Abstinence Scoring Tool (FNAST)

Assess/score infants every 3-4 hours 1/2 to 1 hour after each feed

Infants with signs of withdrawal have signs in each of systems (CNS, GI, other)

Score designed for term infants, adjustments must be made for preterm infants or infants beyond the initial newborn period

Patient ID: Name: Today's Weight: DOB: Date:
AM PM
Signs & Symptoms Time Comments
Central Nervous System Disturbances SCORE  
Crying: Excessive High Pitched
Crying: Continuous High Pitched
2
3
Sleeps < 1hr After Feeding
Sleeps < 2hrs After Feeding
Sleeps < 3hrs After Feeding
3
2
1
Hyperactive Moro Reflex
Markedly Hyperactive Moro Reflex
2
3
Mild Tremors: Disturbed
Mod/Severe Tremors: Disturbed
1
2
Mild Tremors: Undisturbed
Mod/Severe Tremors: Undisturbed
3
4
Increased Muscle Tone 2
Excoriation (Specific Area) 1
Myoclonic Jerk 3
Generalized Cconvulsions 5
Metabolic, Vasomotor and Respiratory Disturbance
Sweating 1
Fever < 101 (37.2 to 38.3°C)
Fever > 101 (38.4°C)
1
2
Frequent Yawning (>3) 1
Mottling 1
Nasal Stuffiness 1
Sneezing (>3) 2
Nasal flaring 1
Respiratory rate (> 60/min)
Respiratory Rate (> 60 Min With Retractions)
1
2
Gastrointestinal Disturbances
Excessive Sucking 1
Poor Feeding 2
Regurgitation
Projectile Vomiting
2
3
Loose stools
Watery Stools
2
3
Score
Total Score
Average Daily Score
Inter-Observer Reliability %
Initials of Scorer 1
Initials of Scorer 2

Adapted from Finnegan, LP, Kaltenbaach, W. The Assessment and Management of Neonatal Abstinence Syndrome. Primary Care, 3rd editions, Hoekelman + Nelson (eds), C.V. Mosby Company, St. Louis, MO, pp 1367-1378, 1992. The FINNEGAN NEONATAL ABSTINENCE SCORE is for the assessment of infants exposed in utero to psychoactive drugs, particularly opiods/opiates. Evaluator should check signs or symptoms 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 symptoms. Copyright, 2007