skip to main content

Neonatal Adaptation Syndrome — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePerinatal PsychiatryNeonatal Adaptation SyndromeMRCPsych Paper B

A 32-year-old woman with a history of severe depression continues sertraline 150 mg daily throughout pregnancy and delivers at 39 weeks. At 8 hours of age, her baby develops jitteriness, irritability, high-pitched crying and difficulty feeding. Temperature, oxygen saturation and capillary blood glucose are normal. There was no maternal fever or prolonged rupture of membranes, and the jittery movements stop when the affected limb is gently held. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Poor neonatal adaptation syndrome

The correct answer is B, poor neonatal adaptation syndrome following late-pregnancy SSRI exposure. The characteristic features are onset within hours of delivery, jitteriness, irritability, abnormal crying and feeding difficulty after continued sertraline use. The underlying mechanism may involve serotonergic effects, withdrawal phenomena, or both, so describing it solely as neonatal withdrawal is imprecise. Early-onset sepsis is less likely without maternal infective risk factors or abnormal neonatal observations. Hypoglycaemia is excluded by the normal glucose measurement. Jitteriness that stops when the limb is held is not typical of an epileptic seizure. Persistent pulmonary hypertension would principally cause respiratory distress, hypoxaemia and cyanosis rather than isolated neurobehavioural and feeding symptoms.

Reference: Electronic Medicines Compendium, Sertraline 20 mg/ml Concentrate for Oral Solution, Summary of Product Characteristics, section 4.6 Pregnancy, revised August 2025: https://www.medicines.org.uk/emc/product/100294/smpc