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Am J Perinatol 2020; 37(02): 224-230
DOI: 10.1055/s-0039-1698458
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nurses' Finnegan Scoring of Newborns with Neonatal Abstinence Syndrome Not Affected by Time or Day of the Week

Alla Kushnir 
1   Department of Pediatrics, Cooper University Health Care, Camden, New Jersey
,
Jennifer L. Bleznak
2   Department of Pediatrics, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
,
Judy G. Saslow
1   Department of Pediatrics, Cooper University Health Care, Camden, New Jersey
,
Gary Stahl
1   Department of Pediatrics, Cooper University Health Care, Camden, New Jersey
› Author Affiliations
Further Information

Publication History

13 February 2019

26 August 2019

Publication Date:
10 October 2019 (online)

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Abstract

Objective Newborns exposed to drugs in utero are at risk of developing neonatal abstinence syndrome (NAS), characterized by behavioral changes and physiologic instability. Finnegan scoring tool quantifies severity of symptoms and guides treatment. This article evaluates whether time of day and the number of shift hours affects modified Finnegan scores, and the subjective component of these scores.

Study Design Institutional review board-approved, retrospective chart review of newborns admitted to neonatal intensive care or transitional nursery from 2011 to 2014. Inclusion criteria: > 35 weeks' gestation, known maternal substance use, positive maternal or newborn urine, or meconium drug screen, NAS treatment.

Results A total of 101 charts were evaluated. Mean treatment duration was 31.8 days (standard deviation ±18.3). There was no significant relationship between observer shift hour and high scores (> 8) (p = 0.83). Highest scores occurred in the afternoon, decreased at night (p = 0.03), and throughout admission (p < 0.0001). Weekend and weekday scores were similar (p = 0.4). The objective component of the scores remained similar throughout the day (p = 0.91) and week (p = 0.52).

Conclusion Finnegan scores given by nurses were not influenced by shift hour. Time of day did not influence overall high scores or the proportion of objective to total Finnegan score. Inter-rater reliability was maintained regardless of time of day or day of the week.

Keywords

neonatal abstinence syndrome - withdrawal - Finnegan scoring - nursing fatigue
 

  • References

  • 1 Administration SAaMHS. 2015 National Survey on Drug Use and Health: Detailed Tables. 2016 . Available at: https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf . Accessed September 16, 2019
    PubMedSearch in Google Scholar
  • 2 Dart RC, Surratt HL, Cicero TJ. , et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med 2015; 372 (03) 241-248
    CrossrefPubMedSearch in Google Scholar
  • 3 Desai RJ, Huybrechts KF, Hernandez-Diaz S. , et al. Exposure to prescription opioid analgesics in utero and risk of neonatal abstinence syndrome: population based cohort study. BMJ 2015; 350: h2102
    Search in Google Scholar
  • 4 Hudak ML, Tan RC, Frattarelli DAC. , et al; COMMITTEE ON DRUGS; COMMITTEE ON FETUS AND NEWBORN; American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics 2012; 129 (02) e540-e560
    CrossrefPubMedSearch in Google Scholar
  • 5 Smith KLR. Women of Childbearing Age and Opioids. In: SAaMHSA, ed. Center for Behavioral Health Statistics and Quality. Rockville, MD: The CBHSQ Report; 2017
    Search in Google Scholar
  • 6 Kocherlakota P. Neonatal abstinence syndrome. Pediatrics 2014; 134 (02) e547-e561
    CrossrefPubMedSearch in Google Scholar
  • 7 Bada HS, Sithisarn T, Gibson J. , et al. Morphine versus clonidine for neonatal abstinence syndrome. Pediatrics 2015; 135 (02) e383-e391
    CrossrefPubMedSearch in Google Scholar
  • 8 Finnegan LP, Connaughton Jr JF, Kron RE, Emich JP. Neonatal abstinence syndrome: assessment and management. Addict Dis 1975; 2 (1-2): 141-158
    PubMedSearch in Google Scholar
  • 9 Disher T, Gullickson C, Singh B. , et al. Pharmacological treatments for neonatal abstinence syndrome: a systematic review and network meta-analysis. JAMA Pediatr 2019; 173 (03) 234-243
    CrossrefPubMedSearch in Google Scholar
  • 10 Patrick SW, Davis MM, Lehman CU, Cooper WO. Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. J Perinatol 2015; 35 (08) 667
    PubMedSearch in Google Scholar
  • 11 Patrick SW, Faherty LJ, Dick AW, Scott TA, Dudley J, Stein BD. Association among county-level economic factors, clinician supply, metropolitan or rural location, and neonatal abstinence syndrome. JAMA 2019; 321 (04) 385-393
    CrossrefPubMedSearch in Google Scholar
  • 12 Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA 2012; 307 (18) 1934-1940
    PubMedSearch in Google Scholar
  • 13 Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM, Patrick SW. Incidence and costs of neonatal abstinence syndrome among infants with Medicaid: 2004–2014. Pediatrics 2018; 141 (04) e20173520
    CrossrefPubMedSearch in Google Scholar
  • 14 Stover MW, Davis JM. Opioids in pregnancy and neonatal abstinence syndrome. Semin Perinatol 2015; 39 (07) 561-565
    CrossrefPubMedSearch in Google Scholar
  • 15 Campo J. Maternal and Newborn Inpatient Stays with as Substance Use or Use-Related Diagnosis. HCUP; 2016
    Search in Google Scholar
  • 16 McQueen K, Murphy-Oikonen J. Neonatal abstinence syndrome. N Engl J Med 2016; 375 (25) 2468-2479
    CrossrefPubMedSearch in Google Scholar
  • 17 Bio LL, Siu A, Poon CY. Update on the pharmacologic management of neonatal abstinence syndrome. J Perinatol 2011; 31 (11) 692-701
    CrossrefPubMedSearch in Google Scholar
  • 18 DʼApolito KC. Assessing neonates for neonatal abstinence: are you reliable?. J Perinat Neonatal Nurs 2014; 28 (03) 220-231
    PubMedSearch in Google Scholar
  • 19 Zahorodny W, Rom C, Whitney W. , et al. The neonatal withdrawal inventory: a simplified score of newborn withdrawal. J Dev Behav Pediatr 1998; 19 (02) 89-93
    CrossrefPubMedSearch in Google Scholar
  • 20 Ista E, van Dijk M, Gamel C, Tibboel D, de Hoog M. Withdrawal symptoms in children after long-term administration of sedatives and/or analgesics: a literature review. “Assessment remains troublesome”. Intensive Care Med 2007; 33 (08) 1396-1406
    CrossrefPubMedSearch in Google Scholar
  • 21 Devlin LA, Lau T, Radmacher PG. Decreasing total medication exposure and length of stay while completing withdrawal for neonatal abstinence syndrome during the neonatal hospital stay. Front Pediatr 2017; 5: 216
    CrossrefPubMedSearch in Google Scholar
  • 22 Finnegan LP. Treatment issues for opioid-dependent women during the perinatal period. J Psychoactive Drugs 1991; 23 (02) 191-201
    CrossrefPubMedSearch in Google Scholar
  • 23 Finnegan LP, Kron RE, Connaughton JF, Emich JP. Assessment and treatment of abstinence in the infant of the drug-dependent mother. Int J Clin Pharmacol Biopharm 1975; 12 (1-2): 19-32
    PubMedSearch in Google Scholar
  • 24 Jones HE, Harrow C, O'Grady KE, Crocetti M, Jansson LM, Kaltenbach K. Neonatal abstinence scores in opioid-exposed and nonexposed neonates: a blinded comparison. J Opioid Manag 2010; 6 (06) 409-413
    CrossrefPubMedSearch in Google Scholar
  • 25 Wachman EM, Farrer LA. The genetics and epigenetics of neonatal abstinence syndrome. Semin Fetal Neonatal Med 2019; 24 (02) 105-110
    CrossrefPubMedSearch in Google Scholar
  • 26 Wachman EM, Hayes MJ, Sherva R. , et al. Variations in opioid receptor genes in neonatal abstinence syndrome. Drug Alcohol Depend 2015; 155: 253-259
    CrossrefPubMedSearch in Google Scholar
  • 27 Wachman EM, Hayes MJ, Sherva R. , et al. Association of maternal and infant variants in PNOC and COMT genes with neonatal abstinence syndrome severity. Am J Addict 2017; 26 (01) 42-49
    CrossrefPubMedSearch in Google Scholar
  • 28 Jansson LM, Di Pietro JA, Elko A, Williams EL, Milio L, Velez M. Pregnancies exposed to methadone, methadone and other illicit substances, and poly-drugs without methadone: a comparison of fetal neurobehaviors and infant outcomes. Drug Alcohol Depend 2012; 122 (03) 213-219
    CrossrefPubMedSearch in Google Scholar
  • 29 Jansson LM, Velez M, Harrow C. The opioid-exposed newborn: assessment and pharmacologic management. J Opioid Manag 2009; 5 (01) 47-55
    PubMedSearch in Google Scholar
  • 30 Osborn DA, Jeffery HE, Cole MJ. Sedatives for opiate withdrawal in newborn infants. Cochrane Database Syst Rev 2010; 10 (10) CD002053
    PubMedSearch in Google Scholar
  • 31 Sarkar S, Donn SM. Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey. J Perinatol 2006; 26 (01) 15-17
    CrossrefPubMedSearch in Google Scholar
  • 32 Newnam S, Collie A, Vogel AP, Keleher H. The impacts of injury at the individual, community and societal levels: a systematic meta-review. Public Health 2014; 128 (07) 587-618
    CrossrefPubMedSearch in Google Scholar
  • 33 Zimmermann-Baer U, Nötzli U, Rentsch K, Bucher HU. Finnegan neonatal abstinence scoring system: normal values for first 3 days and weeks 5-6 in non-addicted infants. Addiction 2010; 105 (03) 524-528
    CrossrefPubMedSearch in Google Scholar
  • 34 Gomez-Pomar E, Christian A, Devlin L. , et al. Analysis of the factors that influence the Finnegan Neonatal Abstinence Scoring System. J Perinatol 2017; 37 (07) 814-817
    CrossrefPubMedSearch in Google Scholar
  • 35 Timpson W, Killoran C, Maranda L, Picarillo A, Bloch-Salisbury E. A quality improvement initiative to increase scoring consistency and accuracy of the Finnegan tool: challenges in obtaining reliable assessments of drug withdrawal in neonatal abstinence syndrome. Adv Neonatal Care 2018; 18 (01) 70-78
    CrossrefPubMedSearch in Google Scholar
  • 36 Retskin CM, Wright ME. Interobserver reliability of the Finnegan neonatal abstinence scoring tool in an acute care setting. J Obstet Gynecol Neonatal Nurs 2014; 43 (S1): S61-S61
    PubMedSearch in Google Scholar
  • 37 Braithwaite M. Nurse burnout and stress in the NICU. Adv Neonatal Care 2008; 8 (06) 343-347
    CrossrefPubMedSearch in Google Scholar
  • 38 Murphy-Oikonen J, Brownlee K, Montelpare W, Gerlach K. The experiences of NICU nurses in caring for infants with neonatal abstinence syndrome. Neonatal Netw 2010; 29 (05) 307-313
    CrossrefPubMedSearch in Google Scholar
  • 39 Heuer L, Bengiamin M, Downey VW, Imler NJ. Neonatal intensive care nurse stressors: an American study. Br J Nurs 1996; 5 (18) 1126-1130
    CrossrefPubMedSearch in Google Scholar
  • 40 Maguire D, Webb M, Passmore D, Cline G. NICU nurses' lived experience: caring for infants with neonatal abstinence syndrome. Adv Neonatal Care 2012; 12 (05) 281-285
    CrossrefPubMedSearch in Google Scholar
  • 41 Maguire DJ. Mothers on methadone: care in the NICU. Neonatal Netw 2013; 32 (06) 409-415
    CrossrefPubMedSearch in Google Scholar
  • 42 Finnegan L. Neonatal abstinence syndrome: assessment and pharmacotherapy. In: Nelson N. , ed. Current Therapy in Neonatal-Perinatal Medicine. Vol. 2. Ontario: BC Decker; 1990
    Search in Google Scholar
  • 43 Gibson KS, Stark S, Kumar D, Bailit JL. The relationship between gestational age and the severity of neonatal abstinence syndrome. Addiction 2017; 112 (04) 711-716
    CrossrefPubMedSearch in Google Scholar
  • 44 Ruwanpathirana R, Abdel-Latif ME, Burns L. , et al. Prematurity reduces the severity and need for treatment of neonatal abstinence syndrome. Acta Paediatr 2015; 104 (05) e188-e194
    CrossrefPubMedSearch in Google Scholar
  • 45 D'Apolito K, Finnegan L. Assessing Signs and Symptoms of Neonatal Abstinence Using the Finnegan Scoring Tool. An inter-observer reliability program. NeoAdvances; 2010 . Available at: https://neoadvances.com/index.html . Accessed September 16, 2019
    PubMedSearch in Google Scholar
  • 46 Maguire D, Cline GJ, Parnell L, Tai CY. Validation of the Finnegan neonatal abstinence syndrome tool-short form. Adv Neonatal Care 2013; 13 (06) 430-437
    CrossrefPubMedSearch in Google Scholar
  • 47 Rochat P. Early Social Cognition: Understanding Others in the First Months of Life. Mahwah, NJ: Lawrence Erlbaum Associates; 2010
    Search in Google Scholar