Table 1.
The 19 individual neonatal abstinence syndrome (NAS) signs that form the total score, scoring scales and objective criteria for positive scores.
| NAS sign | Scoring scale | Objective criteria for positive scoresa |
|---|---|---|
| Crying | 0, 2, 3 | 2 = inconsolable >15 seconds OR cry intermittently for <5 minutes 3 = inconsolable >15 seconds AND cry intermittently for >5 minutes |
| Sleep | 0, 1, 2, 3 | 0 = sleeps more than 3 hours after feeding 1 = sleeps 2–3 hours after feeding 2 = sleeps 1–2 hours after feeding 3 = sleeps <1 hour after feeding |
| Hyperactive Moro reflex | 0, 1, 2 | 1 = arms up 3–4 seconds, jitteriness present 2 = arms up for 5 seconds or more |
| Disturbed tremors | 0, 1, 2 | 1 = hands or feet, up to 3 seconds 2 = arms or legs >3 seconds |
| Undisturbed tremors | 0, 1, 2 | 1 = hands or feet, up to 3 seconds 2 = arms or legs >3 seconds |
| Increased muscle tone | 0, 1, 2 | 1 = flex/extend difficult, head lag present 2 = no flex/extend, no head lag |
| Excoriation | 0, 1, 2 | 1 = skin red and intact, or healing, no longer broken 2 = skin broken |
| Generalized seizure | 0, 8 | 8 = tonic-clonic, subtle staring, chewing, arching |
| Fever | 0, 1 | 1 = temp ≥ 37.3°C |
| Frequent yawning | 0, 1 | 1 = 4 or more in past 3–4-hour observation period |
| Sweating | 0, 1 | 1 = wet on forehead, upper lip |
| Nasal stuffiness | 0, 1 | 1 = any nasal noise |
| Sneezing | 0, 1 | 1 = 4 or more in past 3–4-hour observation period |
| Tachypnea | 0, 2 | 2 = respiratory rate >60/minute |
| Poor feeding | 0, 2 | 2 = uncoordinated gulping and frequent stops |
| Vomiting | 0, 2 | 2 = vomits whole feeding or 2 or more times during feed |
| Loose stools | 0, 2 | 2 = ½ liquid, ½ solid or liquid without water ring |
| Failure to thrive | 0, 2 | 2 = current weight ≥ 10% below birth weight |
| Excessive irritability | 0, 1, 2, 3 | 1 = consoling calms infant in 3–5 minutes 2 = consoling calms infant in 6–15 minutes 3 = consoling calms in >15 minutes or not at all |
Signs listed in the order they appeared on the instrument.
a
For every sign except sleep, a score of 0 = not present. This table is an adaptation of Fig. 2 in the Supplementary Appendix from Jones et al. [22]. Both the original item definitions [39] and the morphine medication protocol [19,24] were refined before initiation of Maternal Opioid Treatment: Human Experimental Research (MOTHER) study data collection.