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The Pediatric Forum
August 2006

Neonatal Adverse Reactions After In Utero Exposure to Selective Serotonin Reuptake Inhibitors: Still Controversial

Arch Pediatr Adolesc Med. 2006;160(8):855-856. doi:10.1001/archpedi.160.8.855-b

Levinson-Castiel et al1 reported neonatal abstinence syndrome (NAS) in 30% of selective serotonin reuptake inhibitor (SSRI)–exposed neonates in late pregnancy using the Finnegan NAS score. Although other reports exist of antidepressant-exposed neonates having a positive Finnegan score,2 the score was designed to assess opiates and not SSRI withdrawal. Moreover, the fact that newborns exposed to SSRIs in late pregnancy share some clinical features compatible with NAS does not indicate that the Finnegan score is representative of the same prevalence of symptoms or that all important symptoms are taken into account. We are currently analyzing data from a retrospective cohort of 66 SSRI- or serotonin-norepinephrine reuptake inhibitor–exposed newborns in late pregnancy; more than 20% showed decreased reactivity and/or decreased tonus during the first 72 hours of life, symptoms that are not assessed by the Finnegan score. Newborns also showed symptoms compatible with NAS in that time frame. Decreased reactivity or tonus have been reported in other cases and studies.3 This discrepancy shows that the etiology of these symptoms is still unclear.

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