Simplification of the Finnegan Neonatal Abstinence Scoring System: retrospective study of two institutions in the USA

Abstract

ObjectiveTo develop a simplified Finnegan Neonatal Abstinence Scoring System (sFNAS) that will highly correlate with scores ≥8 and ≥12 in infants being assessed with the FNAS.Design, setting and participantsThis is a retrospective analysis involving 367 patients admitted to two level IV neonatal intensive care units with a total of 40 294 observations. Inclusion criteria included neonates with gestational age ≥37 0/7 weeks, who are being assessed for neonatal abstinence syndrome (NAS) using the FNAS. Infants with a gestational age <37 weeks were excluded.MethodsA linear regression model based on the original FNAS data from one institution was developed to determine optimal values for each item in the sFNAS. A backward elimination approach was used, removing the items that contributed least to the Pearson’s correlation. The sFNAS was then cross-validated with data from a second institution.ResultsPearson’s correlation between the proposed sFNAS and the FNAS was 0.914. The optimal treatment cut-off values for the sFNAS were 6 and 10 to predict FNAS scores ≥8 and ≥12, respectively. The sensitivity and specificity of these cut-off values to detect FNAS scores ≥8 and ≥12 were 0.888 and 0.883 for a cut-off of 6, and 0.637 and 0.992 for a cut-off of 10, respectively. The sFNAS cross-validation resulted in a Pearson’s correlation of 0.908, sensitivity and specificity of 0.860 and 0.873 for a cut-off of 6, and 0.525 and 0.986 for a cut-off of 10, respectively.ConclusionThe sFNAS has a high statistical correlation with the FNAS, and it is cross-validated for the assessment of infants with NAS. It has excellent specificity and negative predictive value for identifying infants with FNAS scores ≥8 and ≥12.

The Epidemic of Neonatal Abstinence Syndrome, Historical References of Its’ Origins, Assessment, and Management

“…The FNASS-short form developed by Maguire et al ( 62 ) proposed a 7-point checklist using the same cutoff value as the FNASS. The simplified FNASS (sFNASS) is a 10-point scale that was statistically derived using the FNASS scores of a database of 185 patients ( 63 ). This was subsequently validated with a different database of 182 infants from another NICU with excellent correlation to the original FNASS.…”

“…The sFNASS proposes cutoff values of 6 and 10 to identify scores of 8 and 12 on the original FNASS. However, a prospective evaluation of the sFNASS is needed ( 63 ).…”

A Practical Approach to Neonatal Opiate Withdrawal Syndrome

“…31,50,60 A simplified Finnegan Neonatal Abstinence Scoring System (sFNAS) was recently developed and validated after a retrospective analysis of Finnegan scores from 367 infants with NOWS. 61 This scoring system is composed of only 10 selected items that correlate with the original FNAS. The sFNAS was solely derived to shorten the FNAS and not to improve on the psychometric properties of the original tool.…”

Development of an abbreviated symptom score for the neonatal abstinence syndrome

“…There are few direct comparisons between the two instruments, but Gomez-Pomar demonstrated a high concordance between FNAS with MNAS in the same hospital over two consecutive years. ( 10 ) In the Gomez-Pomar study, there were 12,847 observations using FNAS and 17,150 observations using MNAS, with a Pearson’s correlation of 0.86 using a score ≥ 9. Sensitivity was 96% and specificity 80% to predict scores ≥ 9 on the MOTHER NAS scale.…”