Table 4.

Neonatal Drug-Withdrawal Scoring System

SignsScore
0123
Tremors (muscle activity of limbs)NormalMinimally increased when hungry or disturbedModerate or marked increase when undisturbed; subside when fed or held snuglyMarked increase or continuous even when undisturbed, going on to seizure-like movements
Irritability (excessive crying)NoneSlightly increasedModerate to severe when disturbed or hungryMarked even when undisturbed
ReflexesNormalIncreasedMarkedly increased
StoolsNormalExplosive, but normal frequencyExplosive, more than 8 d
Muscle toneNormalIncreasedRigidity
Skin abrasionsNoRedness of knees and elbowsBreaking of the skin
Respiratory rate/minute<5555–7576–95
Repetitive sneezingNoYes
Repetitive yawningNoYes
VomitingNoYes
FeverNoYes
  • Reprinted with permission from Lipsitz PJ. Clin Pediatr. 1975;14:592–594.