Withdrawal Scoring Sheet (In Utero Drug Exposure)

Assesses the severity of neonatal withdrawal symptoms in infants exposed to substances in utero.

Cry / agitation*

None / not presentcry_0

Crying / agitated 25 - 50% of intervalcry_2

Crying / agitated >50% of intervalcry_3

Sleep*

Normal / not scoredsleep_0

Sleeps > 75% of intervalsleep_1

Sleeps 26 - 75% of intervalsleep_2

Sleeps < 25% of intervalsleep_3

Moro reflex*

Normalmoro_0

Hyperactive Moro reflexmoro_2

Markedly hyperactive Moro reflexmoro_3

Tremors disturbed*

Nonetd_0

Mild tremors disturbedtd_1

Moderate - severe tremors disturbedtd_2

Tremors undisturbed*

Nonetu_0

Mild tremors undisturbedtu_3

Moderate - severe tremors undisturbedtu_4

Increased muscle tone*

Excoriation*

Myoclonic jerks*

Generalized convulsions*

Sweating*

Temperature*

Not scored / below 37.2 Ctemp_0

Temperature 37.2 - 38.3 Ctemp_1

Temperature 38.4 C or highertemp_2

Frequent yawning (> 3 - 4 times per interval)*

Moaning*

Nasal stuffiness*

Sneezing (> 3 - 4 times per interval)*

Nasal flaring*

Respiratory rate*

Normal / not scoredrr_0

Respiratory rate > 60/minrr_1

Respiratory rate > 60/min with retractionsrr_2

Excessive sucking*

Poor feeding*

Regurgitation / vomiting*

Nonegi_0

Regurgitationgi_2

Projectile vomitinggi_3

Stools*

Normalstool_0

Loose stoolsstool_2

Watery stoolsstool_3