neonatology

Finnegan Neonatal Abstinence Scoring Tool (FNAST)

21-item scoring system assessing severity of neonatal abstinence syndrome (NAS) in neonates born to mothers using opioids or other substances. Scored every 3–4 hours. Total score guides pharmacological treatment initiation and weaning.

Cry*

Sleep after feeding*

Moro reflex*

Tremors*

Increased muscle tone*

Excoriation (chin, knees, toes, nose)*

Myoclonic jerks*

Generalised convulsions*

Sweating*

Temperature*

Frequent yawning (>3–4 times per 5-min observation)*

Mottling*

Nasal stuffiness*

Sneezing (>3–4 times per 5-min observation)*

Nasal flaring*

Respiratory rate*

Excessive sucking*

Poor feeding (infrequent/uncoordinated suck)*

Regurgitation (≥2 times during/post feeding)*

Projectile vomiting*

Stools*

Score interpretation

Score < 8 — Non-Pharmacological Care 0–7

Finnegan score below 8

→ Non-pharmacological care: swaddling, reduced stimulation, skin-to-skin contact, small frequent feeds, breastfeeding if appropriate and safe; continue 3–4 hourly scoring; involve social work if maternal substance use ongoing

Score 8–11 — Treat if Persistent 8–11

Score ≥ 8: pharmacological treatment is indicated if three consecutive scores are ≥ 8

→ Rescore every 3–4 hours; neonatal team review; start pharmacological treatment per local protocol if three consecutive scores are ≥ 8; continue non-pharmacological measures

Score ≥ 12 — Treat if Repeated 12–99

Score ≥ 12: pharmacological treatment is indicated if two consecutive scores are ≥ 12

→ Rescore promptly; neonatologist review; start pharmacological treatment per local protocol (oral morphine per a children's formulary) if two consecutive scores are ≥ 12; NICU/SCN admission; safeguarding

Interpretation bands for the Finnegan NAS Score. Apply clinical judgement and local guidance.

References

Finnegan LP et al. Neonatal abstinence syndrome: assessment and management. Addict Dis. 1975;2(1–2):141–158.
Gomez Pomar E, Finnegan LP, et al. Simplification of the Finnegan Neonatal Abstinence Scoring System. BMJ Open. 2017;7:e016176.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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