Necrotizing enterocolitis associated with in utero and breast milk exposure to the selective serotonin reuptake inhibitor, escitalopram

Potts, Amy; Young, K L; Carter, B S; Shenai, Jayant P.

doi:10.1038/sj.jp.7211640

Cited by 27 publications

(11 citation statements)

References 14 publications

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“…Potts et al l(21) reported an case of necrotizing enterocolities (NEC) on the fifth postnatal day in a term neonate exposed to escitalopram (20 mg daily) in utero and during breastfeeding. The mother continued taking escitalopram and discontinued breastfeeding.…”

Section: Selective Serotonin-reuptake Inhibitors (Ssri)mentioning

confidence: 99%

Antidepressant Medication Use During Breastfeeding

Scalea

Wisner

2009

Clinical Obstetrics &Amp; Gynecology

114

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We performed an electronic search by using MEDLINE, PreMEDLINE, Current Contents, Biological Abstracts, and PsycINFO from June 2002 through December 2008 using the following terms: "antidepressant drugs", "antidepressive agents", "human milk", "lactation", and "breastfeeding" and the generic name of each antidepressant. Articles in the English language with reports of antidepressants in maternal serum or breast milk, infant serum, and short-term and longterm clinical outcomes in the infants were obtained. The search yielded a total of 31 empirical papers. Breastfeeding and antidepressant treatments are not mutually exclusive. Sertraline, paroxetine, nortriptyline and imipramine are the most evidence-based medications for use during breastfeeding. KeywordsAntidepressant; breastfeeding; nursing infant Human milk represents the ideal primary source of nutrients, immunological defenses, and growth-promoting factors for the term and preterm newborn, and provides the mother-infant dyad with major short and long-term health benefits. Breastfed infants have less risk of mortality and morbidity (i.e. gastrointestinal and respiratory infections, urinary infections, sepsis, meningitis, necrotizing enterocolitis). Breastfeeding continues to offer health benefits into and after early childhood. These include decreased risk for asthma, inflammatory bowel disease, diabetes mellitus and hematological cancers during infancy, as well as lower rate of obesity and asthma in adolescence. Breastfeeding also provides benefits for the mother's health. It has been associated with reduced risk of ovarian cancer and breast cancer, as well as post partum weight retention and bleeding (1)(2). Moreover, the intimate bodily contact during breastfeeding comprises the initial interpersonal communication and facilitates mother -infant attachment. Both the American Academy of Pediatrics and the World Health Organization recommended the use of exclusive breast milk for 6 months for all infants with the option of adequate substitutes only for infants who cannot be breast fed (2)(3).

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Section: Selective Serotonin-reuptake Inhibitors (Ssri)mentioning

confidence: 99%

Antidepressant Medication Use During Breastfeeding

Scalea

Wisner

2009

Clinical Obstetrics &Amp; Gynecology

114

View full text Add to dashboard Cite

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“…Such alterations in the mucosal-derived serotonin contribute to intestinal dysmotility (48) and have been associated with inflammatory bowel disease (75). Importantly, NEC has been associated with maternal use of selective serotonin reuptake inhibitors during pregnancy (76).…”

Section: Resultsmentioning

confidence: 99%

Global Hypoxia-Ischemia Induced Inflammation and Structural Changes in the Preterm Ovine Gut Which Were Not Ameliorated by Mesenchymal Stem Cell Treatment

Nikiforou

Willburger

Jong

et al. 2016

Mol Med

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Perinatal asphyxia, a condition of impaired gas exchange during birth, leads to fetal hypoxia-ischemia (HI) and is associated with postnatal adverse outcomes including intestinal dysmotility and necrotizing enterocolitis. Evidence from adult animal models of transient, locally induced intestinal HI has shown that inflammation is essential in HI-induced injury of the gut. Importantly, mesenchymal stem cell (MSC) treatment prevented this HI-induced intestinal damage. We therefore assessed whether fetal global HI induced inflammation, injury and developmental changes in the gut and whether intravenous MSC administration ameliorated these HI-induced adverse intestinal effects. In a preclinical ovine model, fetuses were subjected to umbilical cord occlusion (UCO), with or without MSC treatment, and euthanized 7 d after UCO. Global HI increased the number of myeloperoxidase-positive cells in the mucosa, upregulated messenger RNA (mRNA) levels of interleukin (IL)-1b and IL-17 in gut tissue and caused T-cell invasion in the intestinal muscle layer. Intestinal inflammation following global HI was associated with increased Ki67 + cells in the muscularis and subsequent muscle hyperplasia. Global HI caused distortion of glial fibrillary acidic protein immunoreactivity in the enteric glial cells and increased synaptophysin and serotonin expression in the myenteric ganglia. Intravenous MSC treatment did not ameliorate these HI-induced adverse intestinal events. Global HI resulted in intestinal inflammation and enteric nervous system abnormalities, which are clinically associated with postnatal complications, including feeding intolerance, altered gastrointestinal transit and necrotizing enterocolitis. The intestinal histopathological changes were not prevented by intravenous MSC treatment directly after HI, indicating that alternative treatment regimens for cell-based therapies should be explored. online address: http://www.molmed.org

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“…Conversely, knockout of SERT, which increases 5‐HT effects by decreasing its reuptake and metabolism, leads to increased NEC inflammation . Although SERT inhibitors (SSRI) are commonly used during pregnancy and lactation, and various behavioral and pulmonary effects on the neonate have been described, only very limited data suggest a link between maternal SSRI use and NEC …”

Section: Implications For Neurogastroenterologymentioning

confidence: 99%

Necrotizing enterocolitis

Sanchez

Kadrofske

2019

Neurogastroenterology Motil

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Necrotizing enterocolitis (NEC) is an acute inflammatory disease of the intestine which primarily affects preterm infants and is a leading cause of morbidity and mortality in the neonatal intensive care unit. From a clinical standpoint, and during the early course of the disease, NEC can be difficult to distinguish from other diseases and conditions common to the preterm infant, and this warrants the need for specific disease biomarkers. The pathogenesis of NEC is only partly understood but likely involves an altered intestinal barrier immune response to feeding and the developing microbiome. Recent evidence points toward a role of the enteric nervous system in NEC pathogenesis. In this issue, Meister and colleagues use a rodent model of NEC to demonstrate that NEC is associated with diminished vagal tone, as determined by decreased high‐frequency heart rate variability (HF‐HRV), and altered myenteric nitrergic inhibitory neurotransmission. These results augment their previous findings that describe decreased HF‐HRV in human preterm infants with NEC. This mini‐review provides a brief summary of clinical and pathophysiologic aspects of NEC with focus on certain aspects of neurogastroenterology.

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Necrotizing enterocolitis associated with in utero and breast milk exposure to the selective serotonin reuptake inhibitor, escitalopram

Abstract: A term neonate presenting with necrotizing enterocolitis following in utero and breast milk exposure to the newest serotonin selective reuptake inhibitor, escitalopram, is described.

Cited by 27 publications

References 14 publications

Antidepressant Medication Use During Breastfeeding

Antidepressant Medication Use During Breastfeeding

Global Hypoxia-Ischemia Induced Inflammation and Structural Changes in the Preterm Ovine Gut Which Were Not Ameliorated by Mesenchymal Stem Cell Treatment

Necrotizing enterocolitis

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