A scoring system was developed by Lipsitz in 1975 to evaluate neonates born to mothers with narcotic addictions. It can be used to monitor infants with evidence of drug withdrawal over time and can help determine if narcotic replacement should be administered.
Parameters:
(1) tremors
(2) irritability and crying
(3) reflexes
(4) stool frequency
(5) muscle tone
(6) skin abrasion
(7) respiratory rate
(8) repetitive sneezing
(9) repetitive yawning
(10) vomiting
(11) fever
|
Parameter |
Finding |
Points |
|
tremors (muscle activity of limbs) |
normal |
0 |
|
|
minimally increased when hungry or disturbed |
1 |
|
|
moderate or marked increase when disturbed; subsides when fed or held snugly |
2 |
|
|
marked increase or continuous, even when undisturbed, going on to seizure-like movements |
3 |
|
irritability (excessive crying) |
none |
0 |
|
|
slightly increased |
1 |
|
|
moderate to severe when disturbed or hungry |
2 |
|
|
marked even when undisturbed |
3 |
|
reflexes |
normal |
0 |
|
|
increased |
1 |
|
|
markedly increased |
2 |
|
stools |
normal |
0 |
|
|
explosive but with normal frequency |
1 |
|
|
explosive, more than 8 per day |
2 |
|
muscle tone |
normal |
0 |
|
|
increased |
1 |
|
|
rigidity |
2 |
|
skin abrasions |
none |
0 |
|
|
redness of knees and elbows |
1 |
|
|
breaking of the skin |
2 |
|
respiratory rate |
< 55 breaths per minute |
0 |
|
|
55 - 75 breaths per minute |
1 |
|
|
76 - 95 breaths per minute |
2 |
|
repetitive sneezing |
no |
0 |
|
|
yes |
1 |
|
repetitive yawning |
no |
0 |
|
|
yes |
1 |
|
vomiting |
no |
0 |
|
|
yes |
1 |
|
fever |
no |
0 |
|
|
yes |
1 |
Table 1, page 593
where:
• For tremors, under score =2, the article says "moderate or marked increase when undisturbed"; this seems inconsistent with the findings on either side, as well as for the pattern shown in irritability.
• The temperature breakpoint for fever is not defined.
• I would assume fever associated with infection or other identifiable would not be scored.
withdrawal score =
= SUM(points for the 11 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
• A score >= 5 was seen in infants born to mothers with narcotic addictions.
• A score <= 4 could be seen in infants born to normal mothers or in unaffected infants born to addicted mothers.
Specialty: Toxicology, Emergency Medicine, Critical Care
