Neonatal Abstinence Syndrome (NAS) /Neonatal Opioid Withdrawal Syndrome (NOWS), Clinical Pathway, Inpatient
Modified Finnegan Scoring: Scoring Tool
Modified Finnegan Score
- 24 Rule:
- 3 consecutive scores ≥ 8 or
- 2 consecutive scores ≥ 12
- Scoring:
- Begin when infant symptomatic or
- by 24 hours of life
- Perform 30 - 60 minutes after feed
- Assess every 3 - 4 hours
- Finnegan Scores < 24
- Provide Non-Pharmacologic Interventions
- Observation
- Finnegan Scoring every 3 - 4 hours
- Finnegan Scores > 24
- Maximize Non-Pharmacologic Interventions
- Provide Pharmacologic Interventions
- Finnegan Scoring every 3 - 4 hours
Consider Substance Half-Life
- First Line Pharmacologic Treatment
- Morphine
- Short Half-Life
- Long Half-Life
- Observe for at least 72 hours
- Discharge if scores are stable
- Observe for 5 - 7 days
- Consider earlier discharge if:
- Finnegan Scores stable
- Home situation stable
- Appropriate follow up arranged
- Second Line Pharmacologic Treatments
- Phenobarbital
- Clonidine may be considered as an alternate second line medication
- Observe infant at least 48 hours after last dose of pharmacologic treatment
- Ensure scores remain < 8
- Discharge Recommendations
- Ensure that a follow-up appointment is scheduled with the PCP by parent prior to discharge
- Notify PCP prior to infant’s discharge
- Refer to Early Intervention
- If mother is Hepatitis C positive, recommend ID follow up and testing
- Encourage postnatal support for mother/family