630 - Multi-Center Randomized Control Trial: Comparison of a Novel Scoring Method with Finnegan score in the treatment of Neonatal Abstinence Syndrome

Publication Number: 2615.630

PRABHAKAR KOCHERLAKOTA, Maria Fareri Children's Hospital at Westchester Medical Center, Newburgh, NY, United States; manuel Decastro, Boston Childrens Health Physicians, Myrtle Beach, SC, United States; Ben Numpang, Maria Fareri Children's Hospital at Westchester Medical Center, Middletown, NY, United States; Matthew Rainaldi, New York Medical College, Valhalla, NY, United States; Rhythm Iqubal, NYU Langone Hospital, Brooklyn, Jersey city, NJ, United States; Hannah Pee, Weill Cornell Medicine, New York, NY, United States; Edmund F.. La Gamma, New York Medical College, Valhalla, NY, United States

Background: Neonatal abstinence syndrome (NAS), or neonatal opioid withdrawal syndrome, is a significant pediatric public health concern. Nonpharmacological therapy remains the mainstay of treatment; however, 20-50% of affected infants require additional pharmacotherapy. The modified Finnegan Neonatal Abstinence Scoring Tool (Finnegan score) is the most widely used system for managing infants with NAS. Despite its prevalence, the Finnegan score is lengthy, complex, time-consuming, and demonstrates poor inter-observer reliability. NASSCORES, a simplified 9-item, user-friendly scoring system, has shown good agreement and correlation with the Finnegan score (Kocherlakota et al., Am J Perinatol 2020; 37:333-340). A score of 4 in NASSCORES corresponds to a score of 8 in the Finnegan system.

Objective: To determine whether using NASSCORES reduces the length of treatment (LOT) compared with the Finnegan score in infants with NAS.

Design/Methods: We conducted an open-label, multicenter randomized controlled trial (RCT) from October 2021 to March 2025 at three hospitals in New York State, including one academic center and two community hospitals. Term infants with NAS unresponsive to nonpharmacological interventions were enrolled and randomly assigned to NAS management guided by either NASSCORES or the Finnegan score. Medication initiation, escalation, and weaning followed standardized, institutionally approved protocols. The primary endpoint was LOT; secondary endpoints included length of stay (LOS) and the use of adjunct medications. Power analysis determined the sample size, designed to detect a 4-day reduction in LOT. Institutional Review Boards at each site approved the study.

Results: Fifty infants were enrolled (25 per group). There were no significant differences between the Finnegan and NASSCORES groups regarding maternal characteristics (age, gestational age, parity, race, prenatal care, substance exposure, or mode of delivery; Table 1) or infant characteristics (sex, birth weight, Apgar scores, opioid used, or feeding method; Table 2). No significant differences were observed in LOT (Finnegan: 19.9 ± 11.8 days; NASSCORES: 17.5 ± 5.6 days; p = ns), LOS (24.9 ± 12.1 vs. 21.5 ± 5.8 days; p = ns), or adjunct medication use (7/25 vs. 2/25; p = ns; Table 3).

Conclusion(s): Use of NASSCORES did not reduce LOT, LOS, or adjunct medication use compared with the Finnegan score in infants with NAS. Given its equivalence and greater simplicity, NASSCORES may serve as a practical alternative to the Finnegan score for the management of NAS.

Table 1: Maternal demographic characteristics of Finnegan group and NASSCORES groups
Table 1 Maternal characteristics PDF.pdfp:ns

Table 2: Demographic characteristics of Infants and the Treatments given to Infants.
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Table 3: Comparison of Results between Finnegan group and NASSCORES group
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