The MOTHER Neonatal Abstinence Syndrome (MNAS) scoring system is based on the Finnegan scoring system. The authors are from multiple institutions in the United States and Europe.
Patient selection: neonate with possible neonatal abstinence syndrome (NAS)
Parameters:
(1) crying
(2) sleeping after feeding
(3) tremors, undisturbed
(4) increased muscle tone
(5) fever °C
(6) tachypnea
(7) poor feeding
(8) vomiting or regurgitation
(9) loose stools
(10) Moro reflex
(11) tremors if disturbed
(12) excoriations
(13) generalized seizures (eyes staring; rapid involuntary eye movements; chewing; back arching; fist clenching; tonic-clonic movements)
(14) frequent yawning (number of successive times)
(15) sweating (wetness on forehead or upper lip)
(16) nasal stuffiness (any nasal noise)
(17) sneezing (number of successive times)
(18) failure to thrive (current weight >= 10% below birth weight)
(19) excessive irritability
|
Parameter |
Finding |
Points |
|
crying |
excessive high-pitched |
2 |
|
|
continuous high-pitched |
3 |
|
sleeping |
< 1 hour after feeding |
3 |
|
|
< 2 hours after feeding |
2 |
|
|
< 3 hours after feeding |
1 |
|
|
other |
0 |
|
tremors if undisturbed |
none |
0 |
|
|
hands or feet only, up to 3 seconds |
1 |
|
|
arms or legs, over 3 seconds |
2 |
|
increased muscle tone |
absent |
0 |
|
|
difficult to straighten arm and head lag present |
1 |
|
|
unable to straighten arm and head lag absent |
2 |
|
fever |
> 37.3°C |
1 |
|
|
<= 37.3°C |
0 |
|
tachypnea |
> 60 breaths per minute |
2 |
|
|
<= 60 breaths per minute |
0 |
|
poor feeding |
takes > 20 minutes, uncoordinated, takes small volume, frequent stops to breath |
2 |
|
|
absent |
0 |
|
vomiting/regurgitation |
vomits whole feeds or >= 2 times per feed when not burping |
2 |
|
|
absent |
0 |
|
loose stools |
half liquid and half stool with or without water rings |
2 |
|
|
absent |
0 |
|
Moro reflex |
normal |
0 |
|
|
hyperactive |
1 |
|
|
markedly hyperactive |
2 |
|
tremors if disturbed |
none |
0 |
|
|
hands and feet only, up to 3 seconds |
1 |
|
|
arms or legs, over 3 seconds |
2 |
|
excoriations |
none |
0 |
|
|
red but intact, no longer broken |
1 |
|
|
not intact |
2 |
|
generalized seizures |
absent |
0 |
|
|
present |
8 |
|
frequent yawning |
0 to 3 successive times |
0 |
|
|
>= 4 successive times |
1 |
|
sweating |
no |
0 |
|
|
yes |
1 |
|
nasal stuffiness |
no |
0 |
|
|
yes |
1 |
|
sneezing |
0 to 3 successive times |
0 |
|
|
>= 4 successive times |
1 |
|
failure to thrive |
no |
0 |
|
|
yes |
2 |
|
excessive irritability |
absent |
0 |
|
|
consoling calms infant in <= 5 min |
1 |
|
|
consoling calms infant in 6 to 15 minutes |
2 |
|
|
consoling takes > 15 minutes or unconsolable |
3 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 42
• The higher the score the more severe the NAS.
Specialty: Toxicology
