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Almost one third of term neonates with prolonged exposure to selective serotonin reuptake inhibitors (SSRIs) in utero have symptoms of neonatal abstinence syndrome (NAS), a recent report shows. Mothers of the 60 infants in the study, which was conducted in Israel, took SSRIs during the entire pregnancy or at least during the third trimester; the SSRIs included fluoxetine, paroxetine, citalopram hydrobromide, sertraline hydrochloride, and venlafaxine hydrochloride. An equal number of healthy neonates whose mothers did not take SSRIs served as the control group.
The infants studied were assessed after birth for NAS, using a protocol that included cardiorespiratory and temperature monitoring, assessment of Finnegan score, and blood testing. The Finnegan score, assessed two hours after birth, then every eight hours after feedings for 48 hours, is used to monitor progression and improvement of NAS symptoms in passively exposed neonates.
Of the 60 neonates exposed to SSRIs in utero, eight showed severe and 10 showed mild symptoms of NAS. All nonexposed neonates had a normal Finnegan score. Of the eight infants with severe NAS, six were exposed to paroxetine, one to fluoxetine, and one to citalopram. Maximum daily symptoms developed within the first 48 hours of life; none of the infants required treatment (Levinson-Castiel R et al: Arch Pediatr Adolesc Med 2006;160:173).