Finnegan Score Calculator

Neonatal abstinence syndrome (NAS) is a set of symptoms that is caused by sudden discontinuation of drug exposure in newborn babies. In other words, the baby experiences a classic withdrawal syndrome, except it was never their choice to take the drug in the first place. However, like any other abstinence syndrome, NAS is a medical condition and can be dangerous to the tiny patient. That's why the Finnegan score was developed — to aid in assessing the baby.

The incidence of infant withdrawal symptoms has been growing recently in the US across all communities and ethnicities.

There are general rules on how to perform and plan the assessments.

1. The assessment should refer to the infant's behavior since the last scoring.
2. The baby should be awake and calm for proper scoring.
3. You should perform the first neonatal abstinence syndrome scoring within the first two hours of life.
4. Subsequent scores should be performed in 4-hour intervals, except when the scoring is ≥8 points — the scoring interval is then shortened to 2 hours for at least 24 hours.
5. If you're performing scores in a 2-hour interval and they're ≤7 for 24 hours, you can return to the 4-hour interval.

If you want to know more about the problems of addiction, check our tools:

1. CIWA calculator;
2. CAGE questionnaire calculator; and
3. Addiction calculator.

To use our calculator:

1. You have to assess the baby's symptoms according to the sections of the scale.
2. The first part is central nervous system disturbances. You have to evaluate, e.g., Moro reflex, the presence of tremors, and the baby's sleeping habits. Check all the conditions that apply to the infant you're assessing.
3. The second big group in the Finnegan score calculator is metabolic, vasomotor, and respiratory disturbances. Here, you need to measure the basic parameters, such as the temperature and respiratory rate. Check every item that refers to the baby.
4. The last group is gastrointestinal disturbances. You might have to ask the mother, or the person feeding the baby, about what the situation looks like. Check all the appropriate items again.
5. Your results are presented at the end of the calculator.
6. The next steps depend strongly on the individual conditions. You can jump to the Finnegan score interpretation section to learn the general rules.

We need to disclose that there is no single strict set of rules to manage the baby withdrawal score result. However, the indications for the introduction of pharmacological treatment of NAS are:

• Supportive, nonpharmacological therapy is unable to control the symptoms.
• NAS scoring remaining high. Some sources give the following definitions of high:
  • Baby withdrawal score is ≥8 points in three consecutive scorings; and
  • Finnegan score calculator shows ≥12 points in two consecutive scorings.
• If the baby experiences seizures, dehydration, or other severe symptoms.

There are two paths of NAS treatment: nonpharmacological and pharmacological. Nonpharmacological therapy is used in every NAS patient and is sufficient in mild cases.

Nonpharmacological treatment options are:

• Demand feeding, frequent feeds, and the use of high-calorie infant formulas;
• Gentle handling, swaddling, holding, cuddling, manual rocking;
• Minimal stimulation — dim lights, low noise;
• Massage therapy, music therapy; and
• Active parental participation.

Pharmacotherapy options include:

• Morphine — the most frequently used drug to treat NAS;
• Methadone;
• Phenobarbital;
• Clonidine; and
• Buprenorphine.

The long-term effects of NAS are still not known and more studies are required. However, we know even today that infant withdrawal syndrome can be linked to more problems in the child's future, such as:

• Developmental delays, intellectual disability, low IQ;
• Language and memory problems;
• Delays in speech and language;
• Motor problems;
• Behavior issues; and
• Learning disabilities and difficulties at school.

The table below represents how you should assign the points using the Finnegan score for NAS: