NAS (Neonatal Abstinence Syndrome) Scoring

Structured Finnegan-based scoring with quick reference dosing. Update selections below to calculate a total and determine the recommended response.

Clinical pearls: use the single highest score from each symptom cluster, reassess every 3 to 4 hours, and confirm with two consecutive scores before escalating therapy.

Score Builder

Central Nervous System

Crying pattern

Sleep after feeding

Tremors

Muscle tone

Myoclonic jerks (3)

Generalized seizures (5)

Metabolic / Vasomotor / Respiratory

Temperature

Sweating (1)

Frequent yawning (≥3 episodes) (1)

Sneezing flurries (≥3 episodes) (1)

Nasal stuffiness (1)

Nasal flaring (2)

Respiratory rate

Gastrointestinal

Feeding difficulty

Emesis

Stool pattern

Excoriations (1)

Poor weight gain (1)

Score Summary

Current total

Baseline observation

Select findings to begin scoring.

Breakdown

Medication Quick Reference

Dose ranges are typical PICU starting doses; adjust for institutional protocols and consult pharmacy.

Medication	Initial dose	Notes
Oral morphine	0.05-0.1 mg/kg PO q3h	Titrate by 0.02 mg/kg; wean by 10% per day once stable.
Methadone	0.05-0.1 mg/kg PO q6h	Consider for polysubstance exposure or prolonged therapy.
Buprenorphine	15 mcg/kg SL q8h	Specialty centers; monitor for respiratory depression.
Phenobarbital	Loading 16-20 mg/kg IV/PO	Add-on for refractory symptoms or polysubstance exposure.