A Review of Neonatal Selective Serotonin Reuptake Inhibitor Withdrawal Syndrome

The purpose of this review is to define "neonatal selective serotonin reuptake inhibitor (SSRI) withdrawal syndrome" (NSWS) from a developmental perspective and outline its management strategies as described in the current body of literature, with a focus on pharmaceutical interventions. A literature search was conducted with PubMed, OVID Medline, Google Scholar, Embase, and Web of Science. Search terms included neonatal and SSRI combined with the Boolean operator "AND" coordinated with the terms withdrawal, poor neonatal adaptation, and neonatal abstinence syndrome. Non-pharmacologic interventions include appropriate hydration, nutrition, and providing a quiet and soothing environment for the infant. Most treatment algorithms for neonatal withdrawal syndromes involve in utero exposure to opioids and other psychotropics, and it is rare to find one that outlines specific guidelines for the management of NSWS. Symptomatic pharmacologic management should be individualized to the patient. Potential measures can include the administration of clonidine for tachycardia, hypertension, diaphoresis, and restlessness; phenobarbital for seizures; or chlorpromazine for agitation and irritability. There is generally no role for the use of morphine or methadone in the treatment of NSWS without combined exposure to opioids in utero. Without studies specifically designed to understand NSWS and guidelines on treatment, there is a lack of clarity regarding the management of neonates with this syndrome. There are limited data differentiating NSWS from neonatal opioid withdrawal despite these disease states being caused by different pharmaceutical agents. There needs to be clear and comprehensive guidelines inclusive of newer studies and comparative treatment efficacies to promote evidence-based practices surrounding NSWS.