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Withdrawal reactions of a premature neonate after maternal use of paroxetine
  1. Medisch Spectrum Twente, Department of Paediatrics
  2. PO Box 50.000, 7500 KA, Enschede
  3. The Netherlands
  4. IlseNijhuis{at}

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Editor—Paroxetine is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) group. Its use during pregnancy can lead to premature birth and neonatal withdrawal symptoms.

A girl was born after 35+2 weeks gestation (birth weight 2690 g) and admitted because of prematurity. The pregnancy and delivery had been uneventful (Apgar score 9/10/10), with no apparent reason for prematurity. There were no problems in the first few days and she drank quickly (bottle feeding).

Thereafter she became irritable, lethargic, and needed tube feeding. She was hypertonic, apathetic, and jittery. The Finnegan score, a behaviour score for neonatal withdrawal reactions, was from day 1 to 10: 0, 0, 2, 2, 9, 9, 6, 6, 7, 7. There were no signs of infection; opiate and metabolic screening were negative. Cerebral ultrasound and an electroencephalogram were normal. The maternal use of paroxetine seemed to be the explanation. The baby improved spontaneously and was discharged at 37+6 weeks gestation. The Finnegan score had returned to zero at day 13. Follow up until four and a half months showed normal (neurological) maturation.

The mother had used paroxetine (40 mg once a day) before and during pregnancy. Her serum paroxetine concentration was 126 μg/l (normal levels 10–150 μg/l) after delivery, when still using the same dose.

We believe that paroxetine (trade name Seroxat) caused the deterioration. Similar neonatal withdrawal reactions have been reported, although not in a premature neonate (SmithKline Beecham Farma; Summary of international databank: 1. Seroxat: discontinuation in neonates; 2. Seroxat: use in pregnancy. 1998).1

The prematurity may also be ascribed to paroxetine as there are reports of premature births after Seroxat use in pregnancy, with the earliest delivery at 25 weeks gestation (SmithKline Beecham Farma;Summary of international databank: 1. Seroxat: discontinuation in neonates; 2. Seroxat: use in pregnancy. 1998). To our knowledge, none of these case reports have been published.

Irritability and jitteriness have been described in full term neonates after the use of other SSRIs.1 ,2 The recommendation for SSRIs and tricyclic antidepressants is that they should not be used during pregnancy unless the potential benefit outweighs the possible risk.1 ,2 As paroxetine is the seventh most commonly prescribed drug in The Netherlands,3 and there may be similar use in other countries, we stress the importance of this message.