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Tesi etd-08312016-114143

Thesis type
Tesi di specializzazione (4 anni)
Neonatal adaptation issues after maternal exposure to prescription drugs: withdrawal syndromes and residual pharmacological effects
Corso di studi
relatore Prof. Blandizzi, Corrado
correlatore Dott. Tuccori, Marco
Parole chiave
  • newborns
  • neonatal syndromes
  • psychotropic drugs
Data inizio appello
Data di rilascio
Riassunto analitico
Exposure to drugs during pregnancy can harm the offspring, causing or teratogenic effects, which are the most feared adverse effects in newborns, or a wide range of less known adverse effects, generally reversible and often acute, that can occur when the mother takes drugs during pregnancy, especially in close proximity to delivery. This thesis aims to describe drugs and drug classes for which licit maternal use in the pre-delivery has been associated with neonatal not teratogenic disorders. Epidemiology, clinical features, biological mechanism and management of these adverse reactions have been thoroughly discussed for each drug class. These adverse reactions were mainly described for substances used illicitly for recreational purposes, but many prescription drugs were also involved, including psychotropic medications, such as opiates, antidepressants, antipsychotics and anti-epileptics. These effects may be partly explained by withdrawal symptoms (also known as 'neonatal withdrawal syndrome') caused by the related suspension of delivery of drugs available from mother to fetus, with symptoms that may include feeding disorders, tremors, irritability, hypotonia / hypertonia, vomiting and persistent crying, occurring a few hours to 1 month after delivery. Otherwise, neonatal neurological and behavioral effects can be caused by a residual pharmacological effect due to an accumulation of the drug in the blood and tissues of the newborn, with various symptoms related to the toxic effects of the specific drug class, usually develop a few hours after birth. With few exceptions, validated protocols for the assessment and management of withdrawal or residual pharmacological effects of these medications in neonates are often lacking or incomplete. Spontaneous reporting of these adverse reactions seem limited, although it could be a useful tool to improve our understanding of drug-induced neonatal syndromes.