Share this Article
Ansary A, Ibhanesebhor SE, Manjunatha CM
Correspondence: Dr Althaf Ansary, dralthaf_ansari@yahoo.com
ABSTRACT
Venlafaxine, a serotonin and norepinephrine reuptake inhibitor, is increasingly used in pregnant women with pre-existing depression who require continued treatment. However, its in uteroeffects on the developing fetus are not clear. Herein, we report the unusual presentation of venlafaxine withdrawal in a female preterm baby of 29 weeks gestation, who presented with myoclonic seizures on her second day of life. The seizures were confirmed using amplitude-integrated electroencephalography, and other possible causes of neonatal seizures were excluded. The baby responded to treatment with phenobarbitone and phenytoin. Magnetic resonance imaging of her brain was unremarkable at corrected gestational age of 39 weeks and 2 days. On follow-up at the corrected age of five months, she was well and developing normally with no further seizures. To the best of our knowledge, this is the first report of seizures in a preterm baby resulting from maternal venlafaxine use.
Keywords: amplitude-integrated electroencephalography, myoclonic seizures, neonatal abstinence syndrome, preterm neonate, venlafaxine
Singapore Med J 2014; 55(4): e57–e59; http://dx.doi.org/10.11622/smedj.2014061
REFERENCES
| 1. Patil AS, Kuller JA, Rhee EH. Antidepressants in pregnancy: a review of commonly prescribed medications. Obstet Gynecol Surv 2011; 66:777-87. http://dx.doi.org/10.1097/OGX.0b013e31823e0cbf | ||||
| 2. Brown CS. Depression and anxiety disorders. Obstet Gynecol Clin North Am 2001; 28:241-68. http://dx.doi.org/10.1016/S0889-8545(05)70199-6 | ||||
| 3. Hostetter A, Ritchie JC, Stowe ZN. Amniotic fluid and umbilical cord blood concentrations of antidepressants in three women. Biol Psychiatry 2000; 48:1032-4. http://dx.doi.org/10.1016/S0006-3223(00)00958-6 | ||||
| 4. Levinson-Castiel R, Merlob P, Linder N, Sirota L, Klinger G. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med 2006; 160:173-6. http://dx.doi.org/10.1001/archpedi.160.2.173 | ||||
| 5. Oberlander TF, Misri S, Fitzgerald CE, et al. Pharmacologic factors associated with transient neonatal symptoms following prenatal psychotropic medication exposure. J Clin Psychiatry 2004; 65:230-7. http://dx.doi.org/10.4088/JCP.v65n0214 | ||||
| 6. Klinger G, Merlob P. Selective serotonin reuptake inhibitor induced neonatal abstinence syndrome. Isr J Psychiatry Relat Sci 2008; 45:107-13. | ||||
| 7. Einarson A, Fatoye B, Sarkar M, et al. Pregnancy outcome following gestational exposure to venlafaxine: a multicenter prospective controlled study. Am J Psychiatry 2001; 158:1728-30. http://dx.doi.org/10.1176/appi.ajp.158.10.1728 | ||||
| 8. De Moor RA, Mourad L, ter Haar J, Egberts AC. [Withdrawal symptoms in a neonate following exposure to venlafaxine during pregnancy]. Ned Tijdschr Geneeskd 2003; 147:1370-2. Dutch. | ||||
| 9. Sanz EJ, De-las-Cuevas C, Kiuru A, Bate A, Edwards R. Selective serotonin reuptake inhibitors in pregnant women and neonatal withdrawal syndrome: a database analysis. Lancet 2005; 365:482-7. http://dx.doi.org/10.1016/S0140-6736(05)17865-9 | ||||
| 10. Pakalapati RK, Bolisetty S, Austin MP, Oei J. Neonatal seizures from in uterovenlafaxine exposure. Paediatr Child Health 2006; 42:737-8. http://dx.doi.org/10.1111/j.1440-1754.2006.00962.x | ||||
| 11. Hoppenbrouwers CJ, Bosma J, Wennink HJ, et al. Neonatal seizures on EEG after in utero exposure to venlafaxine. Br J Clin Pharmacol 2010; 70:454-6. http://dx.doi.org/10.1111/j.1365-2125.2010.03714.x | ||||
| 12. Sankar MJ, Agarwal R, Aggarwal R, Deorari AK, Paul VK. Seizures in the newborn. Indian J Pediatr 2008; 75:149-55. http://dx.doi.org/10.1007/s12098-008-0023-8 | ||||
| 13. Volpes JJ. Neonatal Seizures. In: Neurology of the newborn. 5th ed. Philadelphia: Saunders Elsevier; 2008, p223-30. | ||||
| 14. Thornberg E, Thiringer K. Normal patterns of cerebral function monitor traces in term and preterm neonates. Acta Paediatr Scand 1990; 79:20-5. http://dx.doi.org/10.1111/j.1651-2227.1990.tb11324.x | ||||
| 15. Olischar M, Klebermass K, Kuhle S, et al. Reference values for amplitude integrated electroencephalographic activity in preterm infants younger than 30 weeks' gestational age. Pediatrics 2004; 113:e61-6. http://dx.doi.org/10.1542/peds.113.1.e61 | ||||
| 16. de Vries LS, Hellström-Westas L. Role of cerebral function monitoring in the newborn. Arch Dis Child Fetal Neonatal Ed 2005; 90:F201-7. http://dx.doi.org/10.1136/adc.2004.062745 | ||||