The patient was discharged home on day of life 44 on a clonidine dose of 1 1

The patient was discharged home on day of life 44 on a clonidine dose of 1 1.5 mcg/kg/dose every 8 hours with close follow-up in the high-risk clinic for continued weaning at home. Discussion Differentiating the symptoms of serotonin toxicity from those of withdrawal in a neonate is usually challenging. dose was titrated up to 4 mcg/kg/dose. This is the first report documenting the use of clonidine to manage serotonin toxicity at birth followed by subsequent neonatal withdrawal associated with maternal antidepressant drug use during pregnancy. strong class=”kwd-title” Keywords: antenatal antidepressants, clonidine, neonatal abstinence syndrome, SSRI toxicity, SSRI withdrawal Introduction Affective disorders are among the most common mental health disorders in women of childbearing age.1,2 Selective NSC 228155 serotonin reuptake inhibitor (SSRI) use during the first trimester has been associated Sema4f with congenital defects, while use during the third trimester has been associated with a constellation of postnatal toxicity and withdrawal symptoms. Antenatal SSRI exposure has also been reported to result in comorbidities such as hypoglycemia, feeding troubles, CNS symptoms, and an increased frequency of respiratory disorders, including prolonged pulmonary hypertension.3,4 Differentiating symptoms of toxicity from those of withdrawal from SSRIs in the newborn is challenging in itself, but further complicating matters is the frequent poly-drug exposure with numerous antidepressant agents with additive effects around the serotonin system. Little is known about the degree and significance of this additive and potentially synergistic effect, particularly in the newborn CNS. Serotonin discontinuation syndrome (SDS) explains the constellation of withdrawal or discontinuation symptoms exhibited by neonates exposed to psychotropic drugs during pregnancy. The ability of these psychotropic brokers to cross the placental barrier results in poor neonatal adaption after discontinuation.1 In neonates, it is hard to discern if the symptoms exhibited postnatally are those of serotonin toxicity or serotonin withdrawal. Withdrawal symptoms and toxicity symptoms are largely overlapping and include jitteriness, tachypnea, hypertonicity, heat instability, and diarrhea.5 These symptoms can be of varying degrees. Symptoms related to toxicity typically appear within the first 12 hours, while withdrawal symptoms typically emerge NSC 228155 within the first 48 hours postnatally. Most symptoms have been described as short-lived but may persist for the first 2 to 6 days of life. Typically, symptoms require only supportive treatment; however, severe symptoms may warrant intervention.1 Currently, there is no accepted consensus around the management of newborns with SDS. Adults who develop SSRI withdrawal following abrupt discontinuation of therapy are usually managed with reinitiation of the SSRI followed by a slow taper. Clearly this is not NSC 228155 an option in the neonate, particularly if the symptoms are actually due to serotonin toxicity, which could further exacerbate the symptoms. Management of SSRI toxicity in adults with serotonin toxicity includes therapies such as benzodiazepines and cyproheptadine; however, currently you will find no recommendations for management of newborns with SDS.6 A limited number of reports exist around the management of serotonin withdrawal syndrome in the neonate, describing use of haloperidol, chlorpromazine, and phenobarbital; however, no consensus on management exists.7 We statement the treatment of a newborn with poor neonatal adaption who exhibited biphasic symptoms of acute toxicity at birth and a plateauing of symptoms, followed by subsequent withdrawal symptomatology. This is the first report documenting the use of clonidine to effectively manage discontinuation syndrome in the newborn. Case A 38-week Caucasian male infant was born via spontaneous vaginal delivery to a 37-year-old gravida 2, para 1 mother with a history significant for major depressive disorder. During pregnancy, the mother was managed with sertraline (200-mg tablet daily), trazodone (150-mg extended-release tablet daily), venlafaxine (150-mg extended-release tablet daily), and buspirone (5-mg tablets three times daily). Maternal history also included current nicotine use (5 smokes daily) and a prior history of alcohol, cocaine, and ecstasy abuse, although use during pregnancy was denied. The delivery was uncomplicated; however, the infant exhibited severe hypertonia and no spontaneous respirations. Resuscitation was performed, and a dose of naloxone was administered, given the maternal opioid exposure during labor and delivery. The infant was resuscitated at delivery, with Apgar scores of 1 1, 6, and 7, and was immediately transported to the NICU on continuous positive airway pressure (CPAP) via Neopuff. Upon admission to NICU, the infant continued to have hypertonia, tremors, hypoglycemia, and feeding issues. He was small.