A Multiple-Methods Study Exploring the Impact of Medication Exposure Among Neonates With In-Utero SSRI Exposure (NeoWISE) who are Breastfed in the First Month of Life
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Authors
Cantin, Christina
Date
2025-05-05
Type
thesis
Language
eng
Keyword
Breastfeeding , Medication exposure , Poor neonatal adaptation syndrome , Newborn withdrawal , Newborn , Perinatal mental health , Lactation , Selective Serotonin Reuptake Inhibitor , SSRI
Alternative Title
Abstract
Background: Perinatal mental health disorders are common; adequate treatment is necessary for maternal, fetal, and newborn well-being. Neonates with in-utero selective serotonin reuptake inhibitor (SSRI) exposure (NeoWISE) may experience withdrawal signs. There is a lack of high-quality evidence to substantiate clinical practice recommendations for this population.
Objective: To explore and develop evidence regarding the impact of in-utero SSRI exposure among newborns who are breastfed in the first month of life.
Methods: Multiple-methods were used in this two-phase study. Phase I, a scoping review using JBI methodology, examined the extent and the type of evidence available in published literature. Phase II, a retrospective cohort study (NeoWISE), determined the impact of newborn feeding method on adverse outcomes and healthcare utilization in this population.
Results: The scoping review included 28 studies, published between 1995 to 2023, representing a total of 393 newborns. Authors used a range of methodologies; case reports were the most common. Most studies included data collected during hospitalization after birth. Newborns were primarily full-term (≥ 37 weeks gestation). Respiratory difficulties were the most noted adverse outcome. The most reported healthcare utilization was admission to the NICU. Severe morbidity was rare. The NeoWISE Cohort included 5,079 newborns, born between April 1, 2012, to March 31, 2020 to beneficiaries of the Ontario Drug Benefit Program, of which 3,321 (65.4%) were exclusively breastfed from birth to hospital discharge. Among the breastfed newborns, 50 (1.5%) had neonatal withdrawal versus 41 (2.3%) newborns who were formula-fed, with no difference in risk of withdrawal (adjRR 0.86, 95% CI 0.56, 1.34). Breastfed newborns as compared with formula-fed newborns had a reduced risk of transfer to the NICU (adjRR 0.80, 95% CI 0.66, 0.97) and prolonged hospital stay (≥ 3 days) (adjRR 0.84, 95% CI 0.72, 0.97), and a higher risk of emergency department visits (adjRR 1.42, 95% CI 1.03, 1.97) and hospital readmission (adjRR 1.78, 95% CI 1.21, 2.62).
Impact: We gain a better understanding of the impact of feeding methods on NeoWISE. The knowledge generated assists in the development of evidence-based newborn feeding and care recommendations to enable shared decision-making between health care providers and perinatal families.