About the Finnegan Score
The Finnegan Neonatal Abstinence Scoring System (often just "the Finnegan score" or Finnegan NAS score) is a bedside tool nurses and neonatal teams use to grade withdrawal signs in newborns who were exposed to opioids or other substances before birth. It was developed by Loretta Finnegan in the 1970s and, in various modified forms, remains one of the most widely used NAS scoring tools. Rather than a lab value, it is a structured symptom checklist scored at regular intervals throughout the newborn's hospital stay.
How the score is built
The full tool has 21 items grouped into three systems, each item worth 1 to 5 points depending on severity:
- CNS disturbances: high-pitched or continuous crying, short sleep after feeding, hyperactive Moro reflex, tremors, increased muscle tone, skin excoriation, myoclonic jerks, and generalized convulsions (up to about 24 points).
- Metabolic/vasomotor/respiratory disturbances: sweating, fever, frequent yawning, mottling, nasal stuffiness, sneezing, nasal flaring, and a fast respiratory rate (up to about 11 points).
- GI disturbances: excessive sucking, poor feeding, regurgitation or projectile vomiting, and loose or watery stools (up to about 9 points).
The total score for an assessment is simply the sum of the points recorded across all three groups. Scoring is typically repeated every 2 to 4 hours, or after each feed, for the duration of monitoring.
Putting the result in context
A low total score suggests minimal or well-controlled withdrawal signs. Many NAS protocols treat a score in the high single digits or low teens as a cue to intensify nonpharmacologic care (swaddling, dim quiet rooms, frequent small feeds) and reassess soon. A common - though not universal - decision rule is to consider pharmacologic treatment after three consecutive scores of 8 or higher, or two consecutive scores of 12 or higher. Exact thresholds and the choice of medication are set by each institution's own protocol, not by the arithmetic alone.
When to consult a professional
This calculator only adds the subscores you enter; it does not observe the infant, verify the underlying symptom checklist, or decide on treatment. Any score, especially one near or above a treatment threshold, should be reviewed with the neonatal care team, who interpret it alongside the exposure history, feeding and weight trends, and the infant's overall clinical picture.