Neonatal Toxicity From Escitalopram Use In Utero: A Case Report

Area of Science:

• Neonatal Abstinence Syndrome
• Pharmacology
• Pregnancy and Reproduction

Background:

• Selective serotonin reuptuptake inhibitors (SSRIs) are commonly prescribed during pregnancy.
• Neonatal behavioral syndrome and serotonin withdrawal are known risks of in utero SSRI exposure.
• Reports of escitalopram-specific neonatal toxicity are limited.

Observation:

• A term infant exposed to 20 mg escitalopram throughout pregnancy presented with lethargy, weak cry, and bradycardia.
• Symptoms progressed to hypertonia, irritability, and high-pitched cry, initially suspected as hypoxic ischemic encephalopathy or seizures.
• Electrocardiogram revealed a prolonged QTc interval (531 ms), with irritability and QTc prolongation persisting for 5 days.

Findings:

• Normal electroencephalogram and computed tomography scan ruled out seizures and structural abnormalities.
• The clinical presentation and QTc prolongation were hypothesized to be secondary to in utero escitalopram exposure, representing serotonin toxicity.
• Infant symptoms resolved by day of life 10 without specific treatment for withdrawal.

Implications:

• This case suggests escitalopram, like other SSRIs, may cause neonatal behavioral syndrome and QTc prolongation.
• Close monitoring for these adverse effects is recommended for infants exposed to escitalopram during pregnancy.
• Further research is warranted to establish the incidence and specific mechanisms of escitalopram-induced neonatal toxicity.