Finnegan NAS Assessment
Evaluate central nervous system, metabolic, vasomotor, respiratory, and gastrointestinal symptoms. Score every 3–4 hours, following institutional protocols for treatment thresholds.
High-pitched cry
Score: 0
Sleep after feeding
Score: 0
Moro reflex
Score: 0
Tremors when disturbed
Score: 0
Tremors when undisturbed
Score: 0
Increased muscle tone
Score: 0
Excoriation
Score: 0
Myoclonic jerks
Score: 0
Generalised seizures
Score: 0
Sweating
Score: 0
Temperature (°C)
Score: 0
Frequent yawning (>3/interval)
Score: 0
Mottling
Score: 0
Nasal stuffiness
Score: 0
Sneezing (>3/interval)
Score: 0
Nasal flaring
Score: 0
Respirations (>60/min)
Score: 0
Excessive sucking
Score: 0
Poor feeding
Score: 0
Regurgitation
Score: 0
Projectile vomiting
Score: 0
Loose stools
Score: 0
Watery stools
Score: 0
Total Finnegan score
0
Range 0–maximum 62 (depending on items scored)
Withdrawal severity
Mild withdrawal
How to Use This Calculator
Observe infant over the scoring interval
Assess symptoms just before feeds, every 3–4 hours. Gather caregiver input on crying, sleep, and feeding.
Select the closest description for each sign
Use standard scoring anchors to maintain consistency between clinicians. Document clinical notes for unusual presentations.
Guide therapy decisions
Combine scores with gestational age, comorbidities, and feeding tolerance when deciding on pharmacologic therapy.
Formula
Total Finnegan score = Σ (scores for each symptom)
Thresholds commonly used:
- <8: Observe, supportive care
- 8–11 (on two consecutive scores): Consider initiating medication
- ≥12 (single score): Initiate medication
Full Description
Neonatal abstinence syndrome occurs when infants withdraw from in utero exposure to opioids or other substances. The Finnegan score standardizes assessment across neurological, metabolic, vasomotor, respiratory, and gastrointestinal domains. Accurate scoring informs when to initiate pharmacologic therapy (morphine, methadone, buprenorphine) and when non-pharmacologic care suffices. Implement alongside supportive measures—rooming-in, breastfeeding when safe, minimising stimulation—and coordinate multidisciplinary follow-up to support families.
Frequently Asked Questions
How frequently should I score?
Typically every 3–4 hours, aligned with feeds. After initiating medication, continue frequent scoring to titrate doses.
Can I use Finnegan for non-opioid exposure?
Yes, but symptoms and thresholds may differ. Some centres use modified scores or the Eat-Sleep-Console approach for polysubstance exposure.
How do I ensure inter-rater reliability?
Provide staff training, use bedside pocket cards, and double-score at shift start to calibrate assessments.
When should I escalate care?
Persistent scores ≥12, seizures, feeding intolerance, or respiratory compromise warrant NICU consultation and potential transfer.