Neonatal abstinence syndrome (NAS) after intrauterine exposure to tramadol

Abstract

Sir, Neonatal abstinence syndrome (NAS) may occur after in utero exposure to a wide spectrum of pharmacological substances w5x. Most commonly, it is related to infants born to drug abusing mothers. In contrast, NAS may also occur in the context of legitimately prescribed maternal medication, and even when taken in recommended doses. The clinical presentation of NAS is variable, however, infants typically present with a combination of neurological, gastrointestinal and respiratory symptoms and the most commonly used assessment tool for the detection and severity scoring of NAS is the Finnegan score w10x. We present a rare case of NAS after maternal treatment with tramadol, prescribed during pregnancy for pain relief after scoliosis operations. A 23-year-old primigravida gave birth to a term female newborn by cesarean section (gestational age 38q0; birth weight 3.1 kg; Apgar scores 8, 8 and 9 at 1, 5 and 10 min; umbilical cord pH 7.27). Pregnancy was uneventful except for chronic medication of tramadol (300 mg/day) due to chronic back pain. After regular postnatal adaptation, first signs of NAS occurred on day 2 of life. Symptoms included increased irritability, tachycardia and vomiting. Laboratory investigations including blood sugar levels were normal. The clinical evaluation using the Finnegan score had maximum values of 17 points on day 3 of life and treatment with oral