285 - Preterm Neonates with In Utero Exposure to Selective Serotonin Reuptake Inhibitors

Poster Number: 285
Publication Number: 285.3106

Background: Selective serotonin reuptake inhibitors (SSRI) increase the risk of persistent pulmonary hypertension in newborns exposed in utero. Recent research has shown that full-term infants exposed to SSRIs in utero were at four times increased risk of requiring the initiation of respiratory support in the delivery room compared to unexposed neonates. However, this association has yet to be assessed in preterm neonates.

Objective: To determine if preterm infants exposed to SSRIs in utero require increased respiratory support in the delivery room compared to those unexposed.

Design/Methods: This was a retrospective cohort study at NorthShore University HealthSystem in Evanston, IL from 2013-2023. Data was extracted from the medical records of preterm infants ( < 37 weeks gestational age (GA)) with and without in utero SSRI exposure, defined as documentation of maternal SSRI use at the time of delivery. Infants with delivery room (DR) resuscitation data were included. The primary outcome was initiation of respiratory support in the DR, which included supplemental oxygen (O2), continuous positive airway pressure (CPAP), positive pressure ventilation (PPV), or endotracheal intubation (ETT). Binary logistic regression was used to calculate odds ratios.

Results: Of the total 3506 infants, 10.7% were exposed to SSRIs in utero. Preterm neonates exposed to SSRIs in utero had increased odds of requiring any respiratory support in the DR compared to unexposed preterm neonates after adjusting for GA (OR=1.66; 95% CI: 1.293-2.131). SSRI exposure was associated with the need for PPV (OR=2.253; 95% CI: 1.688-3.006) and CPAP (OR=1.631; 95% CI: 1.254-2.121) after adjusting for GA, but not O2 or ETT. In infants 32-36 6/7 weeks gestation, SSRI exposure was also associated with requiring PPV (OR=2.197; 95% CI: 1.54-3.314) and CPAP (OR=1.698; 95% CI: 1.241-2.323) but not O2 or ETT. In neonates < 32 weeks, SSRI exposure was associated with requiring PPV (OR=2.093; 95% CI: 1.295-3.382), but not O2, CPAP, or ETT.

Conclusion(s): Exposure to SSRIs in utero is associated with significantly greater odds of initiation of respiratory support in the DR for preterm neonates, even when adjusting for baseline risk related to GA. Specifically, both strata of preterm neonates had increased odds of requiring PPV in the delivery room and those 32-37 weeks GA demonstrated increased odds of requiring CPAP. The mechanisms underlying these findings should be further explored.