Neonatal abstinence syndrome — structured clinical viva

This is a liaison and systems viva, not a pure neonatology dose-calculation station. The candidate must hold three threads: (1) medical management of NOWS with supportive care first; (2) accurate use of MOTHER/Suarez so buprenorphine is not framed as cruelty nor methadone as obsolete; (3) ethics — rooming-in and parental presence are therapeutic, not a threat to “objective scoring.”[1][2][4]

Assessment models. Finnegan-type scores structure observation but can drive threshold morphine and prolonged stays if non-pharmacologic care is weak. ESC asks whether the infant can eat, sleep, and be consoled, maximising parental consoling before medication. Young NEJM 2023 supports shorter time to medical readiness with ESC vs usual care in implementing centres.[3][5][7]

Sertraline caveat. SSRI poor neonatal adaptation can overlap with opioid withdrawal — history matters; still treat function and exclude medical mimics.[4][5]

Maternal OAT choice. MOTHER: buprenorphine-exposed neonates needed less morphine and shorter stays vs methadone, with higher maternal discontinuation on buprenorphine. Suarez cohort reinforces favourable neonatal outcomes with buprenorphine at scale. Switching a stable mother to methadone solely “to be kinder” is not evidence-based and may worsen neonatal burden; the kinder act is retention, bonding, and skilled neonatal care.[1][2]

Separation request. Default NICU separation “for objective scores” often worsens withdrawal and bonding. NICU is for clinical need (severity, monitoring, staffing), not stigma. Safeguarding is risk-based; therapeutic OAT + treatable NOWS is not automatic removal.[4][5]

Pharmacotherapy. If function fails: unit protocol opioids (morphine common; methadone alternatives; specialised neonatal buprenorphine per Kraft trial in equipped centres). Adjuncts specialist-only.[5][6]