Effetti neonatali del fumo di sigaretta in gravidanza: descrizione di un caso clinico

Abstract

The paper describes the case of a second child born by iterative caesarean section at 38 weeks + 5 days after pregnancy complicated by maternal smoking (20 ciga-rettes/day) and gestational diabetes on dietary therapy. At birth, regular adaptation to extrauterine life. Neonatal weight 4,150 g (LGA > 97°pct). On the second day of life, limbs tremors, masticatory clonus and hyperexcitability were observed. After excluding metabolic causes (hypoglycaemia, dyselectrolythemia), sepsis and seizures, in the suspicion of neonatal abstinence syndrome, a urine dosage of the most common substances of abuse, nicotine and its metabolites, was carried out. The high value of Trans-3-OH-Cotinine, the main metabolite of nicotine, together with the negativity for other substances, confirmed the suspicion of nicotine withdrawal syndrome. The newborn was kept under strict parametric monitoring in a low sensory stimulation environment. Hyperexcitability, increased tone, acute crying and tremors continued through the fifth day of life: Finnegan score 9, 8 and 5 respectively on the second, third and fifth day of life. Subsequently, there was a progressive improvement and the patient was discharged on the ninth day of life. Currently, at the paediatric and neuropsychiatric follow-up at the first month of life, the newborn is in regular growth and their neurological examination is normal and age-appropriate. The use of tobacco products during pregnancy is one of the most important modifiable risk factors associated with adverse maternal, foetal and ne-onatal outcomes. In utero tobacco exposure is associated with increased risk of placental abruption, prematurity, low birth weight, foetal malformations, stillbirths and sudden unexpected infant death (SUID). Studies on infants born to mothers who smoke have reported an in-crease in signs of stress such as irritability and hypertonicity compared to those born to mothers who do not smoke.