The Neonatal Withdrawal Inventory is a simplified method for assessment of a neonate for signs and symptoms of drug withdrawal. The inventory is rapid (about 10 minutes to complete), flexible and easy to administer.
Method for examining the neonate:
(1) observation of the infant, undisturbed in its bassinet, for 1 minute
(2) unswaddling and gentle awakening
(3) determination of the respiratory rate for 1 minute
(4) measurement of the axillary temperature
(5) inspection of the extremities for signs of excoriation
(6) assessment of muscle tone and Moro reflex
(7) diaper change
(8) reswaddling and positioning
(9) observation of infant for 1 minute without intervention
Parameters used in score:
(1) hypertonicity
(2) Moro reflex
(3) tremors
(4) sneezing or yawning
(5) sweating or mottling
(6) regurgitation
(7) stools
(8) crying and excoriations
|
Parameter |
Finding |
Points |
|---|---|---|
|
muscle tone |
hypertonic |
2 |
|
|
not hypertonic |
0 |
|
Moro reflex |
hyperactive |
2 |
|
|
not hyperactive |
0 |
|
tremors |
when undisturbed |
4 |
|
|
when disturbed |
3 |
|
|
absent |
0 |
|
sneezing or yawning |
> 2 per examination session |
1 |
|
|
absent |
0 |
|
sweating or mottling |
present |
2 |
|
|
absent |
0 |
|
regurgitation |
present |
2 |
|
|
absent |
0 |
|
stools |
loose and watery |
2 |
|
|
formed |
0 |
|
crying and excoriations |
continuous crying |
4 |
|
|
fresh excoriation of limbs (with or without crying) |
3 |
|
|
crying or frantic fist sucking |
2 |
|
|
irritability and restlessness, even after intervention |
1 |
|
|
all of the above absent |
0 |
from Figure 1, page 91
neonatal withdrawal inventory score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 19
• A score >= 8 was the threshold for starting pharmacotherapy (with paregoric).
Purpose: To evaluate a newborn for drug withdrawal using the Neonatal Withdrawal Inventory.
Specialty: Toxicology, Emergency Medicine, Critical Care
Objective: severity, prognosis, stage, adverse effects
ICD-10: P96.1, Z86.4,
