Improving the Assessment of Neonatal Abstinence Syndrome (NAS)

Claire A Chin Foo; Lynne M Dansereau; Katheleen Hawes; Erica L Oliveira; Barry M Lester

doi:10.3390/children8080685

Improving the Assessment of Neonatal Abstinence Syndrome (NAS)

Children (Basel). 2021 Aug 9;8(8):685. doi: 10.3390/children8080685.

Authors

Claire A Chin Foo¹, Lynne M Dansereau¹, Katheleen Hawes^{1

2}, Erica L Oliveira¹, Barry M Lester^{1

2

3}

Affiliations

¹ Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI 02912, USA.
² Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI 02908, USA.
³ Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI 02912, USA.

Abstract

Neonatal Abstinence Syndrome (NAS) is a public health problem of epidemic proportions. The Finnegan Neonatal Abstinence Scoring System (FNASS) is the tool most widely used to evaluate NAS. However, it is limited by its lack of interrater reliability and standardized approach. Surveys to evaluate the FNASS were distributed to nurses at the Women and Infants Hospital in Providence, RI, USA. Infants (n = 78) treated for NAS and born to methadone-maintained mothers were examined to compare items administered from the FNASS and the NICU Network Neurobehavioral Scale (NNNS). All nurses reported that the FNASS was somewhat to very subjective. More than half reported that it was somewhat to not accurate and a new scoring method is needed to accurately diagnose NAS. Correlations between FNASS items and NNNS items showed 9 of 32 (28.1%) correlations were strong (r_s > 0.5), 5 of 32 (15.6%) were moderate (0.3 < r_s < 0.5), and 10 of 32 (31.3%) were weak (0.1 < r_s < 0.3). Principal component factor analysis (PCA) of the NNNS explained more variance (35.1%) than PCA of NNNS and FNASS items combined (33.1%). The nursing survey supported the need for developing a more objective exam to assess NAS. NNNS exam items may be used to improve the evaluation of NAS.

Keywords: Finnegan Neonatal Abstinence Scoring System (FNASS); NICU Network Neurobehavioral Scale (NNNS); Neonatal Abstinence Syndrome (NAS); Neonatal Opioid Withdrawal Syndrome (NOWS).