Time for the Finnegan Neonatal Abstinence Syndrome Scoring Tool to Be Retired?

Abstract Objective Newborns exposed to drugs in utero are at risk of developing neonatal abstinence syndrome (NAS), characterized by behavioral changes and physiologic instability. Finnegan scoring tool quantifies severity of symptoms and guides treatment. This article evaluates whether time of day and the number of shift hours affects modified Finnegan scores, and the subjective component of these scores. Study Design Institutional review board-approved, retrospective chart review of newborns admitted to neonatal intensive care or transitional nursery from 2011 to 2014. Inclusion criteria: > 35 weeks' gestation, known maternal substance use, positive maternal or newborn urine, or meconium drug screen, NAS treatment. Results A total of 101 charts were evaluated. Mean treatment duration was 31.8 days (standard deviation ±18.3). There was no significant relationship between observer shift hour and high scores (> 8) (p = 0.83). Highest scores occurred in the afternoon, decreased at night (p = 0.03), and throughout admission (p < 0.0001). Weekend and weekday scores were similar (p = 0.4). The objective component of the scores remained similar throughout the day (p = 0.91) and week (p = 0.52). Conclusion Finnegan scores given by nurses were not influenced by shift hour. Time of day did not influence overall high scores or the proportion of objective to total Finnegan score. Inter-rater reliability was maintained regardless of time of day or day of the week.

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Evaluation and analysis of the Modified Finnegan Scoring System for assessment of neonatal abstinence syndrome

Journal of Opioid Management ◽

10.5055/jom.2020.0567 ◽

2020 ◽

Vol 16 (3) ◽

pp. 189-196

Author(s):

Rafia Q. Baloch, MD ◽

Jamie M. Pinto, MD ◽

Patricia Greenberg, MS ◽

Yen-Hong Kuo, PhD ◽

Anita Siu, PharmD, BCPPS

Keyword(s):

Vital Sign ◽

Scoring System ◽

Neonatal Intensive Care ◽

Primary Outcome ◽

Assessment Tool ◽

Vital Signs ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Scoring Tool ◽

Study Setting

Objective: The Finnegan Neonatal Abstinence Scoring System (FNASS) is the most commonly used scoring system for neonatal abstinence syndrome (NAS) both in its original and modified versions, despite challenges related to tool length and observer bias. The purpose of this study was to determine the most frequent symptoms of NAS that led to score elevation and prompted initiation of drug therapy on the Modified Finnegan (MF). We also sought to identify vital sign changes associated with score elevation.Design: We conducted a retrospective study of neonates diagnosed with NAS, based on ICD-9 codes and charge data for methadone administration.Setting: The study setting was in a Level III Neonatal Intensive Care Unit.Patients, Participants: Ninety patients with a total of 286 MF scores recorded from 2011 to 2015 met inclusion criteria.Main Outcome Measure(s): The primary outcome was overall occurrence for each specific component of the MF scoring tool during symptomatic periods. Secondary outcomes were vital sign changes.Results: Among the MF elements, there were 13 components that were scored more often than others in symptomatic infants. Respiratory rate (RR) was elevated in infants with NAS, but other vital signs did not differ from age-specific norms. Conclusions: Of the various signs of NAS used to score the MF, few are frequently observed. Our study reinforces literature that proposes a shortened MF assessment tool. Experimental research will be needed to determine the efficacy of a shortened MF tool for diagnosing NAS.

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Neonatal Abstinence Syndrome: Essentials for the Practitioner

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-19.3.147 ◽

2014 ◽

Vol 19 (3) ◽

pp. 147-155 ◽

Cited By ~ 1

Author(s):

Anita Siu ◽

Christine A. Robinson

Keyword(s):

Adjunctive Therapy ◽

Primary Treatment ◽

Neonatal Abstinence Syndrome ◽

Placebo Control ◽

Abstinence Syndrome ◽

Management Options ◽

Optimal Care ◽

Relative Safety ◽

Scoring Tool ◽

Opioid Replacement Therapy

The incidence of neonatal abstinence syndrome (NAS) has increased dramatically during the past 15 years, likely due to an increase in antepartum maternal opiate use. Optimal care of these patients is still controversial because of the available published literature lacking sufficient sample size, placebo control, and comparative pharmacologic trials. Primary treatment for NAS consists of opioid replacement therapy with either morphine or methadone. Paregoric and tincture of opium have been abandoned because of relative safety concerns. Buprenorphine is emerging as a treatment option with promising initial experience. Adjunctive agents should be considered for infants failing treatment with opioid monotherapy. Traditionally, phenobarbital has been used as adjunctive therapy; however, results of clonidine as adjunctive therapy for NAS appear to be beneficial. Future directions for research in NAS should include validating a simplified scoring tool, conducting comparative studies, exploring home management options, and optimizing management through pharmacogenomics.

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Evaluation of a Neonatal Abstinence Syndrome Training Program on Correct Use of the Finnegan Scoring Tool and Nurse Confidence

Journal of Obstetric Gynecologic & Neonatal Nursing ◽

10.1016/j.jogn.2019.04.190 ◽

2019 ◽

Vol 48 (3) ◽

pp. S113 ◽

Cited By ~ 1

Author(s):

Angela Clark

Keyword(s):

Training Program ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Scoring Tool

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Effect of a Neonatal Abstinence Syndrome Training Program on Nurses’ Confidence and Ability to Use the Finnegan Scoring Tool

Nursing for Women s Health ◽

10.1016/j.nwh.2019.09.005 ◽

2019 ◽

Vol 23 (6) ◽

pp. 485-493 ◽

Cited By ~ 1

Author(s):

Angela F. Clark

Keyword(s):

Training Program ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Scoring Tool

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A Comparison of Morphine Delivery in Neonatal Opioid Withdrawal

Substance Abuse Research and Treatment ◽

10.4137/sart.s34550 ◽

2016 ◽

Vol 10s1 ◽

pp. SART.S34550 ◽

Cited By ~ 1

Author(s):

Brian Chisamore ◽

Safaa Labana ◽

Sandra Blitz ◽

Alice Ordean

Keyword(s):

Intensive Care Unit ◽

Neonatal Intensive Care ◽

Opioid Withdrawal ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Chart Audit ◽

Newborn Period ◽

Treatment Protocols ◽

Scoring Tool ◽

Delivery Models

Current estimates of the prevalence of opioid withdrawal in newborns from the 2012 Better Outcomes Registry and Network Ontario reveal that more than 4 births per 1000 display recognizable symptoms of neonatal abstinence syndrome (NAS). With a growing consensus surrounding aspects of newborn opioid withdrawal care, clinicians might agree that all infants exposed to maternal opioids require supportive observation and care to ensure appropriate adaptation and growth in the newborn period and, likewise, that there exists a smaller percentage of newborns who require additional pharmacotherapy. However, due to the dearth of comparative studies of NAS tools, there remains a lack of evidence to support the use of a specific NAS method of scoring or treatment. Two types of NAS treatment protocols currently in use include a symptom-only versus weight-based protocols. Our Neonatal Intensive Care Unit (NICU) has used both models. A formal structured NAS tool and weight-based morphine delivery system began in our NICU in 1999. We audited all newborns with known exposure to maternal opioids in our NICU from the years 2000 to 2014. The Finnegan scoring tool was used throughout all years of the chart audit. Modifications made to the Finnegan scoring tool from the MOTHER study were adapted for use in our NICU at the same time as adopting the Johns Hopkins model of symptom-only based morphine delivery in 2006. The objective of this comparative study using a retrospective chart audit is to compare length of stay (LOS) and total accumulative morphine dose across these two morphine delivery protocols. Our audit revealed that there were a significantly higher proportion of newborns in the symptom-only model that received morphine and, perhaps accordingly, also had a significantly higher LOS compared to those in the weight-based model. Comparing only those infants who did receive morphine, the comparative total accumulative dose of morphine and LOS were not significantly different between the weight-based and symptom-only morphine delivery models.

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Pairing Best Practices to Reduce Length of Stay with Neonatal Abstinence Syndrome: The Finnegan Scoring Tool and Cue-Based Feedings

Pediatrics and Neonatal Nursing Open Access ◽

10.16966/2470-0983.108 ◽

2016 ◽

Vol 2 (1) ◽

Author(s):

Garcia KR

Keyword(s):

Length Of Stay ◽

Best Practices ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Scoring Tool

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Definitions of neonatal abstinence syndrome in clinical studies of mothers and infants: an expert literature review

Journal of Perinatology ◽

10.1038/s41372-020-00893-8 ◽

2021 ◽

Author(s):

Shahla M. Jilani ◽

Chloe J. Jordan ◽

Lauren M. Jansson ◽

Jonathan M. Davis

Keyword(s):

Clinical Studies ◽

Review Process ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Inclusion Criteria ◽

Public Health Data ◽

Full Text Review ◽

Rising Incidence ◽

Definition Of ◽

Scoring Tool

AbstractNeonatal abstinence syndrome (NAS) results from discontinuation of in utero exposures to opioids/substances. The rising incidence of NAS has prompted an increased need for accurate research and public health data. To examine how NAS has been defined in clinical studies of opioid-exposed mothers and infants, a review process was developed based on the RAND/UCLA Appropriateness Method, yielding 888 abstracts. Per inclusion criteria, 57 abstracts underwent full-text review. To define NAS, studies cited using modified versions of the Finnegan NAS scoring tool (n = 21; 37%), ICD-9/10 coding (n = 17; 30%), original Finnegan tool (n = 16; 28%), Eat Sleep Console (n = 3; 5%), and Lipsitz (n = 3; 5%) tools, (3 cited 2+ tools). Most studies utilized subjective NAS scoring/assessment algorithms and neonatal coding as key elements defining NAS. While most cited opioid exposure as integral to their inclusion criteria, 26% did not. These approaches highlight the need for a more refined and standardized definition of NAS.

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