Treating Neonatal Abstinence Syndrome from Clinical Perspectives

Abstract

Background: The Finnegan scoring system which is used to initiate and guide neonatal abstinence syndrome (NAS) therapy has several limitations that make it difficult to be used by many healthcare providers. Therefore in practice many experienced clinicians use their clinical judgements for initiating and continuation of NAS treatment. Objectives: Assessing the degree of association between clinical judgments of experienced neonatologists and the Finnegan scoring system to initiate NAS treatment, and identifying the most prevalent items of the Finnegan scoring system which are independently associated with the need for NAS treatment. Methods: This multi-centric prospective cohort study evaluated 60 admitted neonates who were born to illicit drugs dependent mothers and exhibited signs and symptoms of NAS. Neonates were evaluated based on the Finnegan scoring system once at birth and every four hours. Three consecutive Finnegan scores of ≥ 8 or two consecutive Finnegan scores of ≥ 12 were considered as the requirement for treatment with morphine. Five expert neonatologists with > 15 years of experience, who were blinded to the Finnegan score results visited the patients and their clinical judgments for initiating the medical treatment for NAS were recorded. Results: Based on the Finnegan scoring system 26.7%, and based on the clinical judgment 30% of neonates required medical treatment. There was an excellent correlation between Finnegan scoring system and clinical judgment of experienced neonatologists (r = 0.75, P < 0.001), which was highly sensitive (87.5%) and specific (90.9%) in detecting neonates with NAS who required medical treatment. Tremor (P < 0.001), convulsion (P = 0.001), projectile vomiting (P = 0.001), increased muscle tonicity (P = 0.02), tachypnea (P = 0.04), and poor feeding (P = 0.04) were the items of the Finnegan score that regardless of their severity were independently associated with the requirement for pharmacologic treatment. Conclusions: In special circumstances when using Finnegan scoring system in regular basis is not applicable, initiating NAS treatment based on the clinical judgments of expert neonatologists can be acceptable. Tremor, convulsion, increased muscle tonicity, tachypnea, projectile vomiting, and poor feeding can be used for screening neonates after birth for early identification of opioid-exposed infants who might require medical treatment.