Poor neonatal adaptation

Poor neonatal adaptation is observed in approximately 10 to 30% of neonates exposed to an SSRI in late pregnancy and has also been observed with other antidepressants. It is a syndrome resembling serotonergic overstimulation in the first few days of life. Neonatal adaptation syndrome increases the likelihood of admission to a neonatal unit and is characterised by:

• central nervous system reactivity (irritability, restlessness, tremor, hyperreflexia, myoclonus and, occasionally, seizures)
• gastrointestinal disturbance (eg feeding difficulties)
• respiratory difficulties
• low Apgar scores.

Do not stop or reduce the dose of an antidepressant in the last few weeks of pregnancy with the aim of avoiding neonatal adaptation syndrome; it does not improve neonatal outcomes and increases the risk of patient relapse.

In most cases, if the infant receives supportive care, the syndrome subsides within 2 weeks.

Consider the above advice in accordance with Principles of psychotropic use during pregnancy and Considerations for antidepressant use in pregnancy.