Neonatal Brain Injury
http://www.100md.com
《新英格兰医药杂志》
To the Editor: In an otherwise superbly informative article, Ferriero (Nov. 4 issue)1 failed to include medication-induced causes of neonatal seizures in Table 2, which shows the differential diagnosis of neonatal seizures according to the day of presentation. This is a serious omission.2 The Canadian Adverse Drug Reaction Monitoring Program issued an advisory on August 9, 2004, for pregnant mothers who take selective serotonin-reuptake inhibitors (SSRIs). The Canadian program reported possible seizures in newborns, particularly in the newborns of women who took these antidepressants in the third trimester of pregnancy.3 Laine et al. reported that neonates were at risk for convulsions and other neurologic sequelae after their mothers ingested fluoxetine or citalopram in the third trimester.4 A recent review of adverse effects of the antidepressant duloxetine noted that this serotonin–norepinephrine reuptake inhibitor (SNRI) interfered with fetal and postnatal development. It also has some adverse side effects in common with previously marketed SSRIs (e.g., fluoxetine) and SNRIs (e.g., venlafaxine) and thus may predispose neonates to the same risk of seizures.5
Stefan P. Kruszewski, M.D.
Pennsylvania Physicians' Health Programs
Harrisburg, PA 17105
joeysdogma@comcast.net
References
Ferriero DM. Neonatal brain injury. N Engl J Med 2004;351:1985-1995.
Child neurology and developmental center, seizure section. (Accessed February 3, 2005, at http://www.childbrain.com.)
Health Canada Online. Advisory. August 9, 2004. (Accessed February 3, 2005, at http://www.antidepressantsfacts.com/2004-08-09-HealthCan-SSRIs-newborns.htm.)
Laine K, Heikkinen T, Ekblad U, Kero P. Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations. Arch Gen Psychiatry 2003;60:720-726.
Abramowicz M, ed. Duloxetine (Cymbalta): a new SNRI for depression. Med Lett Drugs Ther 2004;46:81-84.
The author replies: Medication-induced causes of neonatal seizures, especially SSRIs, were included in Table 2, under the category "intoxication," although specific drugs were not listed. A complete history that includes maternal diet, the use of medications for maternal illnesses, and the use of illicit drugs is always indicated in the evaluation of neonatal seizures.
Studies of humans and nonhuman primates indicate that fetal exposure to SSRIs can affect the transport of serotonin in utero,1 but the full influence of these drugs on the developing nervous system is yet to be determined.2 Several studies have indicated that exposure to SSRIs in utero can adversely affect neurobehavior in the newborn period.1 One prospective study of the effects of maternal use of SSRIs during pregnancy on newborn behavior noted increased tremulousness,3 a symptom that is often mistaken for seizures. In the study by Laine et al., in which neonatal behavior associated with drug withdrawal was measured, signs of SSRI withdrawal appeared to be most prominent during the first four days of life.4
Donna M. Ferriero, M.D.
University of California at San Francisco
San Francisco, CA 94143-0663
dmf@itsa.ucsf.edu
References
Anderson GM. Peripheral and central neurochemical effects of the selective serotonin reuptake inhibitors (SSRIs) in humans and nonhuman primates: assessing bioeffect and mechanisms of action. Int J Dev Neurosci 2004;22:397-404.
Wen SW, Walker M. The use of selective serotonin reuptake inhibitors in pregnancy. J Obstet Gynaecol Can 2004;26:819-822.
Zeskind PS, Stephens LE. Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehavior. Pediatrics 2004;113:368-375.
Laine K, Heikkinen T, Ekblad U, Kero P. Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations. Arch Gen Psychiatry 2003;60:720-726.
Stefan P. Kruszewski, M.D.
Pennsylvania Physicians' Health Programs
Harrisburg, PA 17105
joeysdogma@comcast.net
References
Ferriero DM. Neonatal brain injury. N Engl J Med 2004;351:1985-1995.
Child neurology and developmental center, seizure section. (Accessed February 3, 2005, at http://www.childbrain.com.)
Health Canada Online. Advisory. August 9, 2004. (Accessed February 3, 2005, at http://www.antidepressantsfacts.com/2004-08-09-HealthCan-SSRIs-newborns.htm.)
Laine K, Heikkinen T, Ekblad U, Kero P. Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations. Arch Gen Psychiatry 2003;60:720-726.
Abramowicz M, ed. Duloxetine (Cymbalta): a new SNRI for depression. Med Lett Drugs Ther 2004;46:81-84.
The author replies: Medication-induced causes of neonatal seizures, especially SSRIs, were included in Table 2, under the category "intoxication," although specific drugs were not listed. A complete history that includes maternal diet, the use of medications for maternal illnesses, and the use of illicit drugs is always indicated in the evaluation of neonatal seizures.
Studies of humans and nonhuman primates indicate that fetal exposure to SSRIs can affect the transport of serotonin in utero,1 but the full influence of these drugs on the developing nervous system is yet to be determined.2 Several studies have indicated that exposure to SSRIs in utero can adversely affect neurobehavior in the newborn period.1 One prospective study of the effects of maternal use of SSRIs during pregnancy on newborn behavior noted increased tremulousness,3 a symptom that is often mistaken for seizures. In the study by Laine et al., in which neonatal behavior associated with drug withdrawal was measured, signs of SSRI withdrawal appeared to be most prominent during the first four days of life.4
Donna M. Ferriero, M.D.
University of California at San Francisco
San Francisco, CA 94143-0663
dmf@itsa.ucsf.edu
References
Anderson GM. Peripheral and central neurochemical effects of the selective serotonin reuptake inhibitors (SSRIs) in humans and nonhuman primates: assessing bioeffect and mechanisms of action. Int J Dev Neurosci 2004;22:397-404.
Wen SW, Walker M. The use of selective serotonin reuptake inhibitors in pregnancy. J Obstet Gynaecol Can 2004;26:819-822.
Zeskind PS, Stephens LE. Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehavior. Pediatrics 2004;113:368-375.
Laine K, Heikkinen T, Ekblad U, Kero P. Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations. Arch Gen Psychiatry 2003;60:720-726.