Key result
A late preterm breast-fed neonate developed serotonin syndrome from maternal fluoxetine use, which resolved upon switching to formula feeds.
Case Report (n=1)
This case highlights the risk of serotonin syndrome in exclusively breast-fed neonates whose mothers are taking high-dose SSRIs, emphasizing the need for awareness and potential blood level monitoring.
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May warrant monitoring breast-fed neonates of mothers on SSRIs for serotonin syndrome; hypothesis-generating and requires prospective validation.
A late preterm presented with tachypnoea, jitteriness, irritability and low grade fever. Blood gas showed a compensated metabolic acidosis. His mother was taking the selective serotonin reuptake inhibitor (SSRI) fluoxetine, 60 mg/day, and he was exclusively breast-fed. The baby's serum level of fluoxetine on day 8 was within the adult therapeutic range and his symptoms were ascribed to fluoxetine toxicity. On changing to formula feeds, his symptoms resolved. SSRIs are commonly administered during pregnancy, but SSRI toxicity in infants is rarely reported. It is possible that this condition is under diagnosed or, alternatively, misdiagnosed as SSRI withdrawal in breast fed infants whose mothers are on SSRIs. There is limited research looking at serotonin excess in neonates, making case reports such as this important in our learning. Increased awareness may prompt more frequent measurements of blood levels in breast-fed infants whose mothers are on SSRIs.
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Morris et al. (2015) conducted a case report in Serotonin syndrome (n=1). Fluoxetine via breast milk was evaluated on Symptom resolution. A late preterm breast-fed neonate developed serotonin syndrome from maternal fluoxetine use, which resolved upon switching to formula feeds.
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