Infants who are exposed to selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft, in the womb are at risk for developing neonatal abstinence syndrome (NAS), a withdrawal disorder characterized by high-pitched crying, tremors, and disturbed sleep, new research suggests.

Fetal exposure to SSRIs has been linked to major congenital malformations, but there is growing evidence that it may also be tied to NAS, senior author Dr. Gil Klinger, from Schneider Children’s Medical Center of Israel in Petah Tiqwa, and colleagues note.

In the present study, symptoms of NAS were compared in 60 term infants with prolonged exposure to SSRIs in the womb, and in 60 similar infants without this exposure. Symptoms were rated using a standard measure called the Finnegan score: 0 to 3 is normal, 4 to 7 is mild NAS, and 8 or above is severe NAS.

The researchers’ findings appear in the Archives of Pediatrics and Adolescent Medicine.

In the SSRI-exposed group, 8 infants had severe NAS and 10 had mild NAS. By contrast, all of the unexposed group had normal Finnegan scores.

Among children with severe NAS, the average maximum Finnegan score occurred within 2 days of birth. However, in a few cases, the maximum score was not reached until 4 days after birth.

“Infants exposed to SSRIs should be closely monitored after birth by using a standardized protocol for a minimum of 48 hours,” the authors advise. “Follow-up of exposed infants, particularly those who develop severe symptoms, is needed to assess the long-term effects of prolonged exposure to SSRIs.”

SOURCE: Archives of Pediatrics and Adolescent Medicine, February 2006.