Published online April 1, 2005
PEDIATRICS Vol. 115 No. 5 May 2005, pp. e508-e511 (doi:10.1542/peds.2004-2329)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Vanhaesebrouck, P.
Right arrow Articles by Goossens, L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Vanhaesebrouck, P.
Right arrow Articles by Goossens, L.
Related Collections
Right arrow Premature & Newborn

ELECTRONIC ARTICLE

Phototherapy-Mediated Syndrome of Inappropriate Secretion of Antidiuretic Hormone in an In Utero Selective Serotonin Reuptake Inhibitor–Exposed Newborn Infant

Piet Vanhaesebrouck, MD, PhD, Freia De Bock, MD, Alexandra Zecic, MD, Claudine De Praeter, MD, PhD, Koenraad Smets, MD, PhD, Kris De Coen, MD and Linde Goossens, MD

From the Department of Neonatology, Ghent University Hospital, Ghent, Belgium

Although selective serotonin reuptake inhibitors (SSRIs) have gained wide acceptance in the off-label treatment of mental disorders in pregnant women, there seems to be an increased risk for serotonergic adverse effects in newborn infants who are exposed to SSRIs during late pregnancy. Hyponatremia as a result of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a relatively common serious side effect of the use of SSRIs in (mostly elderly) adults. Severe hyponatremia as a result of an SIADH is proposed here as part of a neonatal serotonin toxicity syndrome in a newborn infant who was exposed prenatally to an SSRI. The definite reversal to normal serum sodium levels after fluid restriction, the lack of any alternative cause for the SIADH, and the positive temporal relation with a high score on a widely used adverse drug reaction probability scale offer solid support for the hypothesis of a causal relationship between the SIADH and the prenatal sertraline exposure in our neonate. Moreover, accumulative data on the acute enhancement of serotonergic transmission by intense illumination led us to hypothesize that phototherapy used to treat hyperbilirubinemia in the newborn infant could have been the ultimate environmental trigger for this proposed new cause of iatrogenic neonatal SIADH. The speculative role of phototherapy as a physical trigger for this drug-related adverse event should be confirmed in other cases by thorough study of the serotonin metabolism, assay of SSRI levels in cord blood, and serial measurement of plasma levels in exposed neonates. As phototherapy is used frequently in jaundiced neonates and an apparently increasing number of infants are born to mothers who take SSRIs, serotonin toxicity in neonates deserves increased attention.

Key Words: neonate • hyponatremia • selective serotonin reuptake inhibitor • syndrome of inappropriate secretion of antidiuretic hormone • serotonin syndrome • phototherapy

Abbreviations: SSRI, selective serotonin reuptake inhibitor • SIADH, syndrome of inappropriate secretion of antidiuretic hormone • CNS, central nervous system • 5-HT, 5-hydroxytryptamine • 5-HIAA, 5-hydroxyindoleacetic acid

Accepted Dec 20, 2004.