Abstract The neonatal abstinence syndrome (NAS) is characterized by a pattern of signs resulting from the cessation of maternal transfer of certain xenobiotics. Manifestations are driven primarily by opioids, though other exposures such as benzodiazepines can worsen the severity of symptoms. Cardinal manifestations of opioid withdrawal reside primarily in autonomic, gastrointestinal, respiratory, and neurologic domains. On the basis of use in the MOTHER trial and other randomized controlled trials, the MOTHER NAS scale represents the de facto standard tool for scoring NAS severity. This instrument is quite long (28 items, 19 contributing to the total score) and potentially redundant, but it is considered the “gold standard” for neonatal physicians treating NAS. The overall goal of this research is to develop a shorter scoring instrument that would be in a high agreement with the “gold standard” MOTHER NAS scale for the purpose of clinical decision-making.