Finnegan Score Calculator

Created by Aleksandra Zając, MD
Reviewed by Łucja Zaborowska, MD, PhD candidate
Based on research by
L.P. Finnegan, J.F. Connaughton Jr, R.E. Kron, J.P. Emich Neonatal abstinence syndrome: assessment and management (1975)See 1 more source
Prabhakar Kocherlakota, MD Neonatal Abstinence Syndrome American Academy of Pediatrics (July 28, 2014)
Last updated: Jun 06, 2022

Our Finnegan score calculator helps you perform neonatal abstinence syndrome scoring on infants in need. Reading on, you'll find out more about the scale itself, the Finnegan score interpretation, and more - like what are the drug baby facial features or how long do drugs stay in a baby's system.

We try our best to make our Omni Calculators as precise and reliable as possible. However, this tool can never replace a professional doctor's assessment. If any health condition bothers you, consult a physician.

What is the neonatal abstinence syndrome scoring system for?

Neonatal abstinence syndrome (NAS) is a set of symptoms that is caused by sudden discontinuation of drug exposure in newly born 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.

Baby withdrawal score use and management

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-hours interval and they're ≤7 for 24 hours, you can return to the 4-hour interval.

How to use the Finnegan score 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 depends strongly on the individual conditions. You can jump to the Finnegan score interpretation section to learn the general rules.

Finnegan score interpretation

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.

Neonatal abstinence syndrome treatment

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 formulas](calc:3248);
  • 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.

Long-term effects of neonatal abstinence syndrome

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.

How do I assign points in Finnegan score?

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

Central nervous system disturbances

Cry

Normal

0 points

Excessive high-pitched cry <5 min

2 points

Continuous high-pitched cry >5 min

3 points

Sleep

Normal

0 points

Sleeps <3 hrs after feeding

1 point

Sleeps <2 hrs after feeding

2 points

Sleeps <1 hrs after feeding

3 points

Moro
reflex

Normal

0 points

Hyperactive

2 points

Markedly hyperactive

3 points

Tremors

None

0 points

Mild tremors: disturbed

1 point

Moderate-severe tremors: disturbed

2 points

Mild tremors: undisturbed

3 point

Moderate-severe tremors: undisturbed

4 points

Increased
muscle tone

No

0 points

Yes

1 point

Excoriation

No

0 points

Yes

1 point

Myoclonic
jerks

No

0 points

Yes

3 points

Generalized
convulsions

No

0 points

Yes

5 points

Metabolic, vasomotor, and respiratory disturbances

Sweating

No

0 points

Yes

1 point

Body
temperature

Normal (up to 37.2°C/99°F)

0 points

37.2-38.3°C (99-100.9°F)

1 point

Over 38.3°C (100.9°F)

2 points

Frequent
yawning

No

0 points

Yes

1 point

Mottling

No

0 points

Yes

1 point

Nasal
stuffiness

No

0 points

Yes

1 point

Sneezing

No

0 points

Yes

1 point

Nasal
flaring

No

0 points

Yes

2 points

Respiratory
rate

Normal (40-60 breaths/minute)

0 points

>60 breaths/minute, no retractions

1 point

>60 breaths/minute with retractions

2 points

Gastrointestinal disturbances

Excessive
sucking

No

0 points

Yes

1 point

Poor
feeding

No

0 points

Yes

2 points

Regurgitation

No

0 points

≥ 2 times during/post feeding

2 points

Projectile
vomiting

No

0 points

Yes

3 points

Stools

Normal

0 points

Loose

2 points

Watery

3 points

FAQ

What are infant withdrawal symptoms?

Most common infant withdrawal symptoms include:

  • Tremors, seizures, twitching;
  • Tight muscle tone;
  • High-pitched cry, excessive cry, irritability;
  • Poor feeding;
  • Vomiting, diarrhea;
  • Breathing problems; and
  • High body temperature.

How long do drugs stay in the baby's system?

There is no one good answer to that - drugs can stay in the baby's body anywhere from a few hours up to 30 days. The fact that something will be detectable or not depends on many factors, including:

  • The type and amount of the drug;
  • The matrix used for testing (meconium, urine, umbilical cord);
  • Individual baby features, like metabolism, genetics;
  • Medical conditions; and
  • Hydration, activity during the day.

What are drug baby facial features?

The facial features of a baby with fetal alcohol spectrum disorder include:

  1. Small head;
  2. Small eye-opening;
  3. Flat midface;
  4. Short nose;
  5. Low nasal bridge;
  6. Thin upper lip;
  7. Micrognathia (small jaw feature);
  8. Smooth philtrum (groove under the nose and above the upper lip);
  9. Epicanthal folds (a fold covering the inner corner of the eye); and
  10. Minor ear abnormalities.

How to perform the Finnegan score for NAS?

To correctly perform the Finnegan score for NAS:

  1. The baby needs to be awake and calm. If the baby's irritated and/or crying, soothe them first.
  2. The complete assessment should reflect the baby's behavior since the last scoring.
  3. Evaluate the central nervous system disturbances.
  4. Next, assess the metabolic, respiratory, and vasomotor features.
  5. Finally, check for gastrointestinal disturbances.
  6. Now sum up the points.
  7. You can also use the Finnegan score calculator to simplify the whole process.
Aleksandra Zając, MD
Central nervous system disturbances
Cry
Normal
Sleep
Normal
Moro reflex
Normal
Tremors
None
Increased muscle tone
No
Excoriation
No
Myoclonic jerks
No
Generalized convulsions
No
Metabolic, vasomotor, and respiratory disturbances
Sweating
No
Body temperature
Normal (up to 37.2°C/99°F)
Frequent yawning
No
Mottling
No
Nasal stuffiness
No
Sneezing
No
Nasal flaring
No
Respiratory rate
Normal (40-60 breaths/minute)
Gastrointestinal disturbances
Excessive sucking
No
Poor feeding
No
Regurgitation
None
Projectile vomiting
No
Stools
Normal
The Finnegan score is 0 points.

Monitor the Finnegan NAS score every 3-4 hours.

Initiate pharmacological treatment if two consecutive scores are ≥12 or three consecutive scores are ≥8.
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