Overdose of ergometrine in the newborn infant: acute symptomatology and long-term outcome.
OBJECTIVE
To document the short- and long-term effects of accidental administration of ergometrine in adult dosage to the newborn infant.


METHODS
The case records of all infants admitted to the Royal Children's Hospital (RCH) since 1970 with a diagnosis of acute ergometrine overdose were reviewed, and details of the acute symptomatology, management, and the neurodevelopmental outcome at follow-up were noted. Similar information was obtained, where available, from previous case reports, and from two major drug information services. Additionally, data relating to administration of uterotonic agents and vitamin K were collected from tertiary perinatal centres around Australia.


RESULTS
Seven cases of neonatal ergometrine overdose were identified at RCH. The major features of the acute toxicity syndrome were: encephalopathy (100% RCH cases, 79% combined cases); seizures (100%, 70%); peripheral vascular disturbances (100%, 83%); and oliguria (43%, 34%). Other important symptoms were hypoxaemia, hypertension and feed intolerance. 86% of RCH cases (72% overall) required ventilatory support. Virtually all symptoms resolved within 4 days, and 86% of RCH infants (86% all cases) were neurologically intact at the time of discharge. Long-term neurodevelopmental outcome was normal in 100% of RCH infants (n=6). All the perinatal centres surveyed give vitamin K in the labour ward soon after delivery, and 7 of 18 (39%) reported using Syntometrine (ergometrine 0.5 mg, Syntocinon 5 IU) routinely during the third stage of labour. Thus the circumstances in which ergometrine overdose can occur still exist in many labour wards around the country.


CONCLUSIONS
Despite the catastrophic initial presentation, the long-term prognosis after neonatal ergometrine overdose appears to be favourable. To prevent further cases of this life-threatening drug error, we recommend that administration of vitamin K be deferred until just prior to, or shortly after, transfer of the newborn infant to the postnatal ward.
Dargaville
P A
PA
Department of Neonatology, Royal Children's Hospital, Melbourne, Australia.
Campbell
N T
NT
D062787:Drug Overdose; D004874:Ergonovine / Q000506:poisoning*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008508:Medication Errors; D010120:Oxytocics / Q000506:poisoning*; D011379:Prognosis; D014812:Vitamin K / Q000008:administration & dosage
D010120:Oxytocics; D014812:Vitamin K; D004874:Ergonovine