title: [Transplacental or breast milk intoxication to clonidine: a case of neonatal hypotonia and drowsiness].
abstract: We report a case of clonidine poisoning in a breastfed newborn. At 2 days of life, this boy presented a consciousness deficit with drowsiness, hypotonia, and suspected generalized seizures. There were no cardiorespiratory problems outside of progressive central apneas beginning the 5th day. Further initial investigations were normal (extensive biological exams, cranial ultrasonography and transfontanellar Doppler, electroencephalography, and brain MRI study), excluding the main causes of neonatal hypotonia (encephalitis, infection, metabolic disorder). However, new medical questioning revealed maternal daily intake of 0.15 mg clonidine for hypertension during and after pregnancy. Since it was impossible to quantify clonidine quantification in newborn serum and breast milk, a weaning test was performed the 9th day. Twenty-four hours after cessation of breastfeeding, complete regression of symptoms was obtained. Poisoning by clonidine after fetal and neonatal exposure through breast milk is rare but severe enough to simulate a neurological disease. Diagnosis is based on the search for drug use and the cessation of breastfeeding if doubt persists. Recovery of normal examination results is then rapid and complete.
authors.affiliation: Service de réanimation pédiatrique et néonatologie, centre hospitalier universitaire de Saint-Étienne, hôpital Nord, 42005 Saint-Étienne, France.
authors.forename: C
authors.initials: C
authors.lastname: Sevrez
authors.affiliation: Service de réanimation pédiatrique et néonatologie, centre hospitalier universitaire de Saint-Étienne, hôpital Nord, 42005 Saint-Étienne, France.
authors.forename: M-P
authors.initials: MP
authors.lastname: Lavocat
authors.affiliation: Centre de pharmacovigilance, centre hospitalier universitaire de Saint-Étienne, 42005 Saint-Étienne, France.
authors.forename: G
authors.initials: G
authors.lastname: Mounier
authors.affiliation: Centre de référence sur les agents tératogènes, hôpital Trousseau, AP-HP, 75571 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Elefant
authors.affiliation: Service de réanimation pédiatrique et néonatologie, centre hospitalier universitaire de Saint-Étienne, hôpital Nord, 42005 Saint-Étienne, France.
authors.forename: S
authors.initials: S
authors.lastname: Magnin
authors.affiliation: Service de réanimation pédiatrique et néonatologie, centre hospitalier universitaire de Saint-Étienne, hôpital Nord, 42005 Saint-Étienne, France; EA SNA-Epis 4607, université Jean-Monnet, 42023 Saint-Étienne, France.
authors.forename: G
authors.initials: G
authors.lastname: Teyssier
authors.affiliation: Service de réanimation pédiatrique et néonatologie, centre hospitalier universitaire de Saint-Étienne, hôpital Nord, 42005 Saint-Étienne, France; EA SNA-Epis 4607, université Jean-Monnet, 42023 Saint-Étienne, France. Electronic address: hugues.patural@chu-st-etienne.fr.
authors.forename: H
authors.initials: H
authors.lastname: Patural
mesh_terms: D003000:Clonidine / Q000493:pharmacokinetics* / Q000506:poisoning* / Q000627:therapeutic use; D003244:Consciousness Disorders / Q000097:blood / Q000139:chemically induced*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000097:blood* / Q000188:drug therapy*; D007231:Infant, Newborn; D008297:Male; D008431:Maternal-Fetal Exchange / Q000502:physiology*; D008895:Milk, Human / Q000378:metabolism*; D009123:Muscle Hypotonia / Q000139:chemically induced*; D011247:Pregnancy; D012640:Seizures / Q000097:blood / Q000139:chemically induced; D020182:Sleep Apnea, Central / Q000097:blood / Q000139:chemically induced; D012894:Sleep Stages / Q000187:drug effects*
chemical_list: D003000:Clonidine