Neonatal Abstinence Syndrome After In Utero Exposure to Selective Serotonin Reuptake Inhibitors in Term Infants

Abstract

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.

Fetal Effects of Selective Serotonin Reuptake Inhibitor Treatment During Pregnancy: Immediate and Longer Term Child Outcomes

“…In the context of prenatal SSRI exposure, the study by Berard et al 74 highlights the critical importance of accounting for dose effects; the association between paroxetine and cardiac defects was not significant until outcomes were stratified by daily dose of paroxetine. A dose effect has also been demonstrated for birth outcomes 24,47 although not all studies have replicated such an effect 20,29,64 . However, investigations of a dose effect have often been conducted utilising groups of infants with different SSRI exposure types.…”

“…Fluoxetine exposure in the second and third trimester was reportedly associated with increased neonatal adaptation problems 36 , with a similar pattern reported for paroxetine and respiratory distress 35 . The study by Levinson-Castiel et al 47 reported a significant correlation between dose of paroxetine and severity of neonatal symptoms.…”

“…SSRIs The prevalence of neonatal adaptation syndrome in exposed neonates was found to be significantly higher in ten studies (11 publications) 20,22,25,27,41,42,[45][46][47][48][49] . Across studies the estimated level of neonatal adaptation symptoms ranged from 5%-30% of SSRI exposed neonates.…”

“…Dose of SSRI and its correlation with neonatal adaptation is infrequently considered. There is evidence of a dose effect for paroxetine 47 , although replication is required. Rates of neonatal adaptation syndrome are reported to differ by type of SSRI due to differences in drug half life 7 .…”

Effect of antidepressants use in pregnancy on foetus development and adverse effects in newborns

“…In most cases, the symptoms appear within the first 8 hours of delivery and persist for the first 2-6 days of life. It is believed that the syndrome will not develop if there are no symptoms within the first two days of life [34]. Withdrawal symptoms and toxicity symptoms are largely overlapping, which is why differentiation based on the clinical picture is extremely difficult.…”