Abstract
Discontinuation syndrome associated with maternal use of antidepressants is presented as the lead article by Hale, Kendall-Tackett, and colleagues. 2 The authors review 930 questionnaires from women who responded to a simple announcement on their website. The mothers were asked to report any of a list of symptoms they had personally observed in their infants in the neonatal period. The impact of maternal medications during pregnancy has been of interest to neonatologists for decades, resulting in case reports of withdrawal from pain medications, anticonvulsants, and even large doses of caffeine in common beverages. Street drugs and therapeutic methadone are reported in large numbers as they result in prolonged hospitalizations for treatment of the withdrawal for the infant. Evaluation of infants with known exposures have been standardized with the Neonatal Abstinence Scoring System first described by Finnegan et al.3,4 in 1975. The American Academy of Pediatrics has attempted to create uniform scoring and terminology using the term “neonatal drug withdrawal.” 5 Moses-Kolko et al. 6 reviewed the literature on neonatal signs of serotonin reuptake inhibitors and coined the term “neonatal behavioral syndrome.” The term “poor neonatal adaptation” has been used by other authors.
This article by Hale, Kendall-Tackett, and colleagues 2 reports the mothers' description of their children's behavior. Most studies report the pediatrician's and neonatal nurse's observations. The authors report more “discontinuation syndrome” when there has been in utero exposure than when medication is started postpartum, which would be expected. The impact of breastfeeding is an important issue. The problem of selective serotonin reuptake inhibitor therapy is significant and increasing in frequency.
Let us hear your thoughts on terminology and assessment with a letter to the editor.
The angst about nipple shields has resurfaced in clinical practice. A review of the issues is presented by McKechnie and Eglash 7 in a very thorough review of the literature. They conclude that the literature does not support the safety or effectiveness of contemporary nipple shield use. The use of nipple shields has swung from a total ban to liberal provision of shields for all. This article is strong evidence in support of careful review case-by-case and a strong defense for moderation. One is tempted to think that there was an influence by commercial resources behind the resurgence.
This issue of the journal contains other interesting clinical reports, including a report of the behavior of women physicians; 8 the protocol in this issue is on pain. 9 The website review is a great description of the new unique and compelling display, Best for Babies. 10