A comparison of two neonatal withdrawal scales: A retrospective case note audit

Aim The aim of this study was to compare the Lipsitz Withdrawal Scale (LWS) and Modified Finnegan Withdrawal Scale (MFWS) with regard to their equivalent ability to guide therapeutic interventions for neonates withdrawing from opioids and non-opioid substances. Method Medical records of 34 patients born between 2000 and 2001 and 28 patients born between 2010 and 2011 at the WCHN were audited, with data collected on neonates scored with either the LWS or MFWS, respectively. Additional information were collected from case notes and hospital databases about the identified neonates. Results There was no difference in treatment initiation between the LWS and MFWS for opioid exposed neonates. Scoring was commenced significantly closer to time of birth for opioid exposed neonates, treated with morphine and assessed with the MFWS. Opioid exposed neonates, treated with both morphine and phenobarbitone were administered significantly higher doses of morphine when assessed with the LWS. Conclusion These findings confirm that the same percentage of neonates are receiving pharmacological intervention irrespective of which scale they are assessed with. Findings also suggest that neonates are now being assessed for symptoms closer to time of birth, potentially leading to quicker treatment initiation, smaller doses of medication and shorter hospital stays. Future prospective studies should be undertaken to compare the two scales further.