A new look at the neonate's clinical presentation after in utero exposure to antidepressants in late pregnancy

Objectives: To identify symptoms in neonates exposed to antidepressants in late pregnancy and to propose a categorization of these symptoms to help clinical assessment of antidepressant effects in exposed neonates. Methods:. Data were extracted retrospectively from maternal and neonatal hospital charts. A total of 73 neonates exposed to antidepressant and 73 nonexposed neonates were included. Neonatal symptoms reported in the literature to be related to antidepressant exposure were collected. Multiple logistic regression analysis was used to estimate the association of neonatal symptoms and antidepressant exposure. Factorial analysis was used to regroup the neonatal symptoms. Results: Increased risk of alertness alteration (odds ratio [OR], 37; 95% confidence interval [CI], 8-174), altered muscular tone (OR, 20; 95% CI 5-71), feeding and GI problems (OR, 3.8; 95% CI 1.7-8.1), tachypnea (OR, 2.5; 95% CI, 1.1-5.3), and neurological problems (8/73 vs 0/73; P = 0.006) were found. Three statistically significant clusters of symptoms associated with antidepressant exposures emerged from the factorial analysis. Two of these clusters were similar to those described in adults for serotonergic toxicity and antidepressant discontinuation syndrome while the other was closely related to neonatal immaturity. Conclusions: Symptoms expressed in neonates exposed to antidepressants in late pregnancy could be gathered in three clusters. This grouping could be useful to develop a new tool helping in the assessment and care of the exposed newborns.