685 - Acute Delivery Room Resuscitation of Neonates Exposed to Selective Serotonin Reuptake Inhibitors: Replicated Findings in Second Patient Population

Pregnancies are commonly affected by maternal depression and anxiety. These conditions are frequently treated pharmacologically with antidepressants, specifically selective serotonin reuptake inhibitors (SSRI). Effects on the neonatal respiratory system ranging from mild tachypnea to severe respiratory distress have been reported after in utero SSRI exposure.  Recent novel data in a small retrospective cohort study demonstrated that in utero SSRI exposure is associated with increased odds of requiring respiratory support in the delivery room as well as neonatal intensive care unit (NICU) admission. 

Objective:

To determine if previous novel findings that full-term neonates with in utero exposure to SSRIs required respiratory support in the delivery room (as indicated by the standardized Neonatal Resuscitation Program [NRP] algorithm) significantly more often than non-exposed neonates were replicable in a second patient population and hospital system.

Design/Methods:

In this retrospective cohort study, data was extracted from medical records of full-term neonates with and without in utero SSRI exposure, defined as documentation of third trimester maternal SSRI treatment.  A hospital-based sample was identified at NorthShore University HealthSystems in Evanston, IL.  Full-term singleton newborns identified in a 2-year period (n=6517) were selected for study. Neonates with a major congenital anomaly were excluded. The primary outcome was initiation of respiratory support in the delivery room, as indicated by the NRP algorithm. Secondary outcomes were NICU admission, one-minute and five-minute Apgar scores. 

Results:

Of the 6517 full-term singleton neonates, 4.9% were exposed to SSRI in utero. Respiratory support was initiated significantly more often in SSRI exposed (16.9%) than unexposed (6.6%) neonates (covariate-adjusted OR= 2.57; 95% CI: 1.88-3.53).  In utero SSRI exposure was also associated with one-minute Apgar score less than or equal to five (covariate-adjusted OR= 2.04, 95% CI: 1.33-3.13).  In contrast to prior study, in utero SSRI exposure was not associated with a higher rate of NICU admission (covariate-adjusted OR= 1.4, 95% CI:0.82-2.40).  

Conclusion(s):

These data continue to demonstrate that in utero SSRI exposure is associated with significantly greater odds of resuscitation in the delivery room and supports novel findings of previous study.  In contrast to prior study, in utero SSRI exposure was not associated with an increased odds of NICU admission.  These findings further support a recommendation that third trimester SSRI exposure be considered a risk factor for needing resuscitation.