To assess the signs and severity of withdrawal in an infant, practitioners use a standardized scoring system such as the system first developed by Finnegan and later modified by Jansson and others.

Notify provider if three scores are greater than 8 or two are greater than 12 for consideration of Neonatology consultation, possible NICU transfer, and/or pharmacologic treatment

Provider quick tips and orders: When admitting an NAS baby, the order for “scoring” using the ESC approach should be entered as a “Notify Provider” order as follows: “Please notify provider if infant is unable to: A. Eat at least 1 ounce per feed or breastfeed well; B. Sleep for at least 1 hour undisturbed; or C. Be consoled

• Score if: mottling (marbled appearance of pink and pale or white areas) is present on the baby’s chest, trunk, arms or legs. Apply mittens if trauma to fingers. Offer pacifier- for nonnutritive sucking.

The Modified Finnegan Neonatal Abstinence Score stratifies severity of opioid withdrawal in newborns.

Each symptom is assigned a score based on its severity and frequency. The total score helps healthcare providers decide on the appropriate treatment pathway. When is Scoring Performed? Scoring is typically initiated within the first 24 hours of life and continues every 3 to 4 hours, aligning with the infant’s feeding schedule.

When using the Finnegan, we recommend consistently promoting non-pharmacological interventions and standardizing the timing and technique of scores across all staff and family members. See below for a step-by-step discussion of how to correctly use the Finnegan Tool.

Several scoring systems are available for use; however, the most widely validated and commonly used is the Finnegan Scoring System (Appendix 1). This 21-item scale, a modified version of the original created in 1975, evaluates multiple signs related to NAS and helps to guide treatment initiation and dosing. Scoring is to quantify the severity of

The FINNEGAN NEONATAL ABSTINENCE SCORE is for the assessment of infants exposed in utero to psychoactive drugs, particularly opioids/opiates. Evaluator should check signs or symptoms observed at various time intervals and add the scores to obtain a total score.

• The first abstinence score should be recorded approximately two hours after birth or admission to the nursery (baseline score). This score reflects all infant behaviour up to the first scoring interval time point. • Following the baseline score all infants should be scored at 4-hourly intervals, except when high