Is there a correlation of Venlafaxin (Efexor®) therapy during pregnancy and a higher incidence of necrotizing enterocolitis?

Abstract

Background: Neonates exposed to Venlafaxine (Efexor®), a serotonin and norepinephrine reuptake inhibitor, are at risk for severe withdrawal symptoms, poor neonatal adaptation including respiratory difficulties and as previously reported necrotizing enterocolitis (NEC). We present twins who both developed necrotizing enterocolitis on the 6th day of life. Objective: The twins were delivered by cesarian section at a gestational age of 33+2 weeks due to persistent vaginal bleeding and contractions secondary to placenta praevia marginalis. Until 4 days before delivery the mother was treated with Venlafaxine (Efexor®) for depression. The pregnancy was otherwise uneventful. Twin A: birthweight 1700g (P15), Apgar 6/ 7/ 8, pHa 7.22. Twin B: brithweight 1980g (P30), Apgar 4/ 5/ 8, pHa 7.24. Both twins were intubated in the first hour of life because of respiratory insufficiency and exceeding need for oxygen. They could be extubated on the second day of life and further treatment was without complications. Enteral feeding was started on the first day of life with maltodextrin® and breast milk. On the 6th day of life twin B developed abdominal distension, sings of peritonitis, bloody stool and gastric residuals. Conservative management was started with intravenous antibiotics and oral feeds were stopped. A few hours later also twin A showed sings of NEC. Apart from clostridium difficile toxin in the stool of twin A stool cultures were negative. Because the conservative therapy in twin B failed surgical intervention was necessary and it showed multiple perforations of the hemorrhagic ischemic colon. Conclusion: Despite of prematurity as a risk factor for NEC we should keep in mind that medication with Venlafaxine (Efexor®) could also have the potential to increase the risk for NEC.