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 (disturbed)*

Increased muscle tone*

Excoriation (chin, knees, toes, nose)*

Myoclonic jerks or generalised seizures*

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

Mild NAS — Non-Pharmacological Management 0–7

Finnegan score <8 — mild NAS symptoms; supportive care sufficient

→ Non-pharmacological care: swaddling, reduced stimulation, skin-to-skin contact, pacifier, breast-feeding if appropriate and safe, small frequent feeds; continue 3–4 hourly assessments; do not start pharmacological treatment; involve social work if maternal substance use ongoing

Moderate NAS — Consider Treatment 8–11

Finnegan score 8–11 — moderate NAS; monitor closely; may require pharmacological treatment

→ If score ≥8 on 3 consecutive observations: initiate pharmacological treatment per local protocol (oral morphine first-line in UK); continue non-pharmacological measures; reassess every 3–4 hours; neonatal team review; NICU/SCN admission if not settling; social care involvement

Severe NAS — Pharmacological Treatment Required 12–99

Finnegan score ≥12 — severe NAS; pharmacological treatment indicated

→ Initiate pharmacological treatment immediately (oral morphine per a children's formulary); NICU/SCN admission; consider adjunct phenobarbital if opioid dose escalating; neonatologist review; monitor sedation, feeding, weight; involve social services, safeguarding if not already done; plan for discharge with community support

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.
NICE NG212. Neonatal abstinence syndrome. National Institute for Health and Care Excellence. 2021.

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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