Send letter to journal:
Re: Feeding difficulty in a term neonate due to Paroxetine withdrawl

We report a case of a term baby with feeding difficulties related to possible maternal Paroxetine use. A baby boy was born at 39 weeks gestation by a normal delivery. He did not have any respiratory effort at birth but had a good heart rate and needed bag and mask ventilation. At 3 hours of age he was admitted from the labour ward because of hypoglycemia and disinterest in feeding. He was started on antibiotics after a partial septic screen, as there were ruptured membranes for 26 hours. No laboratory evidence of infection was found.

He continued to remain lethargic, mildly hypotonic with poor head control and not at all interested in feeding. There was no irritability or jitteriness. Cranial ultrasound and metabolic screen were negative. At day 8 he was reviewed by speech and language therapist who observed very little reaction to teat in the mouth. She suggested a cherry topped teat to stimulate the back of the tongue and to rub the teat around the side of the gums, to use dummy during spoon feeds. Despite all these strategies and repeated reviews he continued to remain disinterested in sucking requiring tube feeds. Progress with feeding was extremely slow however by day 21 at discharge he had a good rhythmic suck. When reviewed in clinic at 5 weeks of age he was reportedly feeding very well, was developmentally normal and demonstrated a good weight gain

Mother had been on Paroxetine 20 mg once a day in pregnancy for obsessive-compulsive disorder. Nijhuis et al[1] report irritability, lethargy and need for tube feeding in a prem baby and irritability and jitteriness have been described in full term neonates but this degree of feeding difficulty in a term neonate is very unusual and prompted us to fill in a report on suspected adverse drug reaction (yellow card) and submit it to the Committee on Safety of Medicines.

Jayesh Bhatt
Specialist Registrar in Paediatrics

Robert C Coombs
Consultant Neonatologist

Special Care Baby Unit
Northern General Hospital
Sheffield S5 7AU, UK

Send letter to journal:
Re: prem birth/taking seroxat

i was taking seroxat(20mg) per day in 2001.i became pregnant and decided that i should stop taking seroxat,as doctors were unable to provide any data to say that it was safe to take during pregnancy.

several weeks later,after terrible withdrawl(which my doctor refused to put down to withdrawl,just sickness in pregnancy)my daughter was born prematurely at 28 weeks gestation.she was 2lb 4oz and very poorly.we had months of agony as she was in the neonatal unit,doctors had no reason for the prem rupture of membranes.

i was convinced then that it was due to the seroxat and still am.

obviously,i became very depressed while our baby daughter was fighting for her life in hospital,so doctors recommended that i start seroxat treatment again. i did,and in the summer of 2002 i became pregnant again with another girl. at the 20 week routine scan,it was confirmed that her arms were considerably shorter than normal and we were referred to a specialist.the scans showed that there were 2 missing radius bones,therfore,the hands turned inwards.

an agonising decision for us to make,but,no-one could confirm a diagnosis of a syndrome,and we were told we would have to wait until the baby was born for a diagnosis.

after the recent problems with our daughter,we could not not have coped with a child in hospital who could have died,so we made a decision that the pregnancy would be terminated. on 26th september i gave birth to abigail grace,at 22weeks gestation.an autopsy showed many problems-missing radius bones,a slight facial abnormality,a ductal liver plate malformation,a sandal gap on both feet.(this is from memory,so not correct medical terms). no syndrome could be matched to these problems,so genetic advice was advised.

one day i hope that someone will be able to say that what happened to us,was a result of my taking seroxat in pregnancy.i know in my heart that it was,we have a healthy 9 year old son,and we are both healthy people.our beautiful daughter made a full recovery and is now nearly 4 years old.

i later came off seroxat which took months and was a horrible experience.i am prone to bouts of depression-and no doctor in the world could ever convince me to take those tablets again-so i muddle through the best i can.

i dont think that seroxat is safe to take during pregnancy,and i wish that data was available to people to show them that.