Effect of Selective Serotonin Receptor Inhibitors on Neonatal Opioid Withdrawal Syndrome Outcomes

BACKGROUND AND OBJECTIVES Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression in pregnant women with opioid use disorder, yet their impact on neonatal opioid withdrawal syndrome (NOWS) is conflicting. This study assesses the severity of NOWS among pharmacologically treated infants with in utero SSRI co-exposure. METHODS Retrospective analysis of infants of at least 35 weeks’ gestation admitted to the neonatal intensive care unit for NOWS pharmacotherapy between 2006 and 2022. NOWS severity indicators included the length of postnatal opioid treatment (LOT), length of hospital stay (LOS), maximum postnatal opioid dose, and the need for secondary medications for NOWS (phenobarbital or clonidine). Infants with NOWS who had in utero SSRI co-exposure were compared with those with NOWS but no SSRI co-exposure using standard statistical tests. RESULTS Among 932 infants with NOWS, 117 had SSRI co-exposure prenatally. Sertraline was the most common SSRI (48.7%). Mode of birth, 5-minute Apgar score, maternal methadone dose, benzodiazepine use, and polysubstance count were different between the groups. In adjusted regression analysis, no significant differences were found in the LOT (adjusted mean difference 0.17 days; 95% CI, −3.44 to 3.78), LOS (adjusted mean difference −0.02 days; 95% CI, −3.92 to 3.89), and maximum postnatal opioid dose between groups. Infants in the NOWS + SSRI group did not have a higher likelihood of requiring secondary medications in the adjusted analysis. CONCLUSION Concurrent prenatal SSRI exposure was not associated with the analyzed severity markers among pharmacologically treated infants with NOWS.