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To the Editor: In their Review of neonatal signs after late in utero exposure to SSRIs, Dr Moses-Kolko and colleagues¹ discussed 13 case reports that described 18 cases of neonatal exposure. We have published a report of 3 cases of neonatal fluoxetine withdrawal secondary to maternal use during pregnancy, which we would like to add to those cited in the Review.²

Similar to other reports, we noted symptoms of a withdrawal syndrome presenting within the first 6 hours of life, not specifically at birth. In our cases, maternal use was at a dosage of 60 to 80 mg/d. The infants demonstrated tachypnea, tachycardia, jitteriness, temperature instability, poor suck, and hyperactivity, consistent with a withdrawal syndrome. Fluoxetine and norfluoxetine levels were measured in all infants prior to breastfeeding. Elevated infant serum norfluoxetine levels (1-265 ng/mL) were recorded. These levels correlated with maternal dosage. Breastfeeding was discouraged during the first 4 weeks . . . [Full Text of this Article]

Bennett Lavenstein, MD
blavenst@cnmc.org
Department of Neurology
Children’s National Medical Center
Washington, DC

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