title: Neonatal Toxicity From Escitalopram UseIn Utero: A Case Report.
abstract: Selective serotonin reuptake inhibitor (SSRI) exposure during pregnancy can result in symptoms of serotonin syndrome or serotonin withdrawal. In contrast to other SSRIs, reports of serotonin behavioral syndrome followingin uteroexposure to escitalopram and citalopram are limited. We describe a case of suspected toxicity followingin uteroexposure to 20 mg escitalopram throughout pregnancy. The infant was transferred to our neonatal intensive unit at 9 hours of life for further evaluation of lethargy, weak cry, bradycardia, and non-reactive pupils. Hypoxic ischemic encephalopathy was suspected upon presentation, despite APGAR scores of 8 and 9. Upon admission, symptoms progressed to signs of hypertonia, irritability, high-pitched cry, and posturing. The patient was loaded with phenobarbital for empiric management of suspected seizures versus drug withdrawal. Both electroencephalogram and computed tomography scan results were normal; however, an electrocardiogram revealed a prolonged QTc interval of 531 milliseconds. Signs of irritability and QTc prolongation continued through day of life (DOL) 5. The infant was discharged on DOL 10 with no further symptoms. We hypothesize that this represented a case of serotonin toxicity due toin uteroexposure to escitalopram and recommend close monitoring for neonatal behavioral syndrome symptoms and QTc prolongation in infants exposed to escitalopram during pregnancy.
authors.affiliation: University of Virginia Health System Children's Hospital, Charlottesville, Virginia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Degiacomo
authors.affiliation: Texas Tech University Health Sciences Center School of Pharmacy, Amarillo, Texas.
authors.forename: Sherry
authors.initials: S
authors.lastname: Luedtke
keywords: adverse drug effect; behavioral syndrome; citalopram; escitalopram; in utero; neonatal behavioral syndrome; pregnancy; selective serotonin reuptake inhibitor