Neonatal Withdrawal Syndrom when Exposure to SSRIs

New research article publised in Archives of Pediatrics and Adolescent Medicine about neonatal abstinence syndrome (NAS). Its when an infant is exposed to selective serotonin reuptake inhibitors (SSRIs) (New Antidepressiva) like Zoloft, Paxil/Seroxat etc. during pregnancy. After birth the infant is at risk for developing neonatal abstinence syndrome (NAS), a withdrawal disorder characterized by high-pitched crying, tremors, and disturbed sleep, new research suggests.

From Reuters/Medscape:

Fetal exposure to SSRIs has been linked to major congenital malformations, but there is growing evidence that it may also be tied to NAS, senior author Dr. Gil Klinger, from Schneider Children’s Medical Center of Israel in Petah Tiqwa, and colleagues note.

In the present study, symptoms of NAS were compared in 60 term infants with prolonged in utero exposure to SSRIs and in 60 similar infants without this exposure. Symptoms were rated using a standard measure called the Finnegan score: 0 to 3 is normal, 4 to 7 is mild NAS, and 8 or above is severe NAS.
The researchers’ findings appear in the Archives of Pediatrics and Adolescent Medicine for February.
In the SSRI-exposed group, 8 infants had severe NAS and 10 had mild NAS. By contrast, all of the unexposed group had normal Finnegan scores.
Among children with severe NAS, the average maximum Finnegan score occurred within 2 days of birth. However, in a few cases, the maximum score was not reached until 4 days after birth.

“Infants exposed to SSRIs should be closely monitored after birth by using a standardized protocol for a minimum of 48 hours,” the authors advise. “Follow-up of exposed infants, particularly those who develop severe symptoms, is needed to assess the long-term effects of prolonged exposure to SSRIs.”

Abstract from original article:

Neonatal Abstinence Syndrome After In Utero Exposure to Selective Serotonin Reuptake Inhibitors in Term Infants
Rachel Levinson-Castiel, MD; Paul Merlob, MD; Nehama Linder, MD; Lea Sirota, MD; Gil Klinger, MD

Arch Pediatr Adolesc Med. 2006;160:173-176.

Objective
To compare the prevalence and clinical characteristics of neonatal abstinence syndrome in neonates exposed and not exposed to selective serotonin reuptake inhibitors (SSRIs) in utero.

Design Cohort study.
Setting Tertiary care center.
Patients One hundred twenty term infants, of whom 60 had prolonged in utero exposure to SSRIs, including paroxetine hydrochloride, fluoxetine, citalopram hydrobromide, sertraline hydrochloride, and venlafaxine hydrochloride.
Main Outcome Measures Neonatal abstinence syndrome was assessed with the Finnegan score as follows: score of 8 or above, severe; score of 4 to 7, mild; and score of 0 to 3, normal. All infants were followed up with a standardized protocol that included repeated Finnegan score assessments and cardiorespiratory monitoring until normalization of the Finnegan score.
Results Of the 60 neonates exposed to SSRIs in utero, 8 showed severe and 10 showed mild symptoms of a neonatal abstinence syndrome. All nonexposed neonates had a normal Finnegan score. In neonates who developed severe symptoms, the maximum mean daily Finnegan scores were recorded within 2 days after birth, although maximum individual scores were recorded as long as 4 days after birth.
Conclusions Neonatal abstinence syndrome occurs in 30% of neonates exposed to SSRIs in utero. These neonates should be monitored for at least 48 hours after birth. The long-term effects of prolonged exposure to SSRIs, particularly in neonates who develop severe symptoms, have yet to be determined.
Author Affiliations: Neonatal Intensive Care Unit, Schneider Children’s Medical Center of Israel, Petah Tiqwa (Drs Levinson-Castiel, Merlob, Linder, Sirota, and Klinger); Department of Neonatology, Rabin Medical Center, Petah Tiqwa (Drs Merlob, Linder, Sirota, and Klinger); and Sackler School of Medicine, Tel Aviv University, (Drs Merlob, Linder, Sirota, and Klinger), Tel Aviv, Israel.

Source: Arch Pediatr Adolesc Med 2006;160:173-176.