Finnegan et al proposed a scoring system in 1975 for evaluating neonates who were born to mothers with drug addiction and who showed signs of drug abstinence. The score can be used for monitoring the affected infant over time, and to help guide drug intervention if needed.
The scoring sheet (pages 143 and 145, Finnegan et al, 1975) shows 33 items which can be divided into 20 parameters.
• Caveat: The items in the original table are given in a simple linear array, but some obviously need to be broken into related categories. The table used below seems reasonable to me, but may not seem appropriate to others.
Schedule for scoring (page 142, Finnegan):
(1) first 24 hours: every hour
(2) second 24 hours: every 2 hours
(3) for days 3-5: every 4 hours, corresponding to nursery feedings
(4) if drug therapy is started, the infant is scored every 4 hours until 2 days after the drug therapy has been discontinued (minimum 5 days after birth)
|
Parameter |
Finding |
Points |
|---|---|---|
|
cry |
not high pitched |
0 |
|
|
high pitched, but not continuous |
2 |
|
|
continuous high pitched |
3 |
|
sleep after feeding |
3 or more hours |
0 |
|
|
2 to less than 3 hours |
1 |
|
|
1 to less than 2 hours |
2 |
|
|
< 1 hour |
3 |
|
Moro reflex |
not hyperactive |
0 |
|
|
hyperactive |
2 |
|
|
markedly hyperactive |
3 |
|
tremor |
none |
0 |
|
|
mild, when disturbed |
1 |
|
|
marked, when disturbed |
2 |
|
|
mild, even when undisturbed |
3 |
|
|
marked, even when undisturbed |
4 |
|
|
generalized convulsions |
5 |
|
muscle tone |
not increased |
0 |
|
|
increased |
2 |
|
sucking of fists |
not frantic |
0 |
|
|
frantic |
1 |
|
feeding |
fair to good |
0 |
|
|
poor |
2 |
|
regurgitation |
not increased |
0 |
|
|
increased |
2 |
|
|
projectile vomiting |
3 |
|
stools |
normal |
0 |
|
|
loose |
2 |
|
|
watery |
3 |
|
hydration |
normal |
0 |
|
|
dehydrated |
2 |
|
yawning |
normal |
0 |
|
|
frequent |
1 |
|
sneezing |
no |
0 |
|
|
yes |
1 |
|
nasal stuffiness |
no |
0 |
|
|
yes |
1 |
|
sweating |
no |
0 |
|
|
yes |
1 |
|
mottling of skin |
no |
0 |
|
|
yes |
1 |
|
temperature |
normal |
0 |
|
|
> 99.5°F but <= 101°F |
1 |
|
|
fever > 101°F |
2 |
|
respiratory rate |
<= 60 breaths per minute |
0 |
|
|
> 60 without retractions |
1 |
|
|
> 60 with retractions |
2 |
|
excoriations on nose |
no |
0 |
|
|
yes |
1 |
|
excoriations on knees |
no |
0 |
|
|
yes |
1 |
|
excoriations on toes |
no |
0 |
|
|
yes |
1 |
where:
• Generalized convulsions were included with tremors, (1) since this was done by Lipsitz (above), and (2) it fit in with the rising scores for tremors.
• The temperature to determine fever is not given. I will be using > 99.5°F (after DC Dale, page 1532, Cecil Textbook of Medicine, 20th edition, 1996.)
drug abstinence score =
= SUM(points for the 20 parameters)
Interpretation:
• minimum score: 0
• maximum score: 39 (based on the above table)
• Since the scores may fluctuate during the first day, an average of 3 hourly scores is used for evaluation.
• An average score > 8 during the first day may be an indication for therapy. On the second day 2 consecutive scores >= 8 may be used as an indication for therapy.
• The score and body weight can be used to guide drug therapy with phenobarbital (Table 2, page 148, Finnegan) or paregoric (Table 3, page 148).
Purpose: To use the drug abstinence score of Finnegan et al from 1975 to help evaluate and manage neonates born to mothers with narcotic addiction.
Specialty: Toxicology, Emergency Medicine, Critical Care
Objective: other testing, severity, prognosis, stage, adverse effects
ICD-10: P96.1, Z86.4,
