Use of SSRIs during pregnancy and possible consequences for the development of the child

Infants of depressed mothers are at increased risk for developing cognitive and behavioural problems. Medication is often prescribed for pregnant women suffering from a major depression. Approximately 2% of Dutch pregnant women is using a selective serotonin reuptake inhibitor (SSRI). SSRIs cross the placenta easily. The consequences of prenatal exposure to SSRIs for the developing child remain to be determined. In the postnatal period, increased incidence of respiratory distress, feeding and digestive disturbances, irritability and convulsions, and admission to a neonatal intensive care unit have been described. Long-term effects have not yet been thoroughly examined in humans. Animal studies have shown permanent changes in specific parts of the brain and altered behaviour in adulthood after perinatal exposure to SSRIs. Research into motor and cognitive development at school age and adolescence in children prenatally exposed to SSRIs is urgently needed.</p

Cholestase bij pasgeborenen als gevolg van parenterale voeding

Toediening van totale parenterale voeding (TPN) aan pasgeborenen is geassocieerd met het ontstaan van cholestase. Ondanks intensief onderzoek zijn de pathofysiologische mechanismen slechts gedeeltelijk opgehelderd. In dit artikel wordt ingegaan op de huidige inzichten in de risicofactoren die geassocieerd zijn met TPN-cholestase bij pasgeborenen, de specifieke bestanddelen en deficiënties van TPN die cholestase kunnen veroorzaken, de mogelijke relatie met de ‘fysiologische cholestase van de pasgeborene’, die de pasgeborene kwetsbaarder maakt voor potentieel hepatotoxische stoffen, en de transportsystemen in de levercelmembraan die betrokken zijn bij galvorming. De hypothese dat ‘cholestatische galzuren’ een rol spelen in de etiologie van TPN-cholestase en de therapeutische mogelijkheden worden besproken.Administration of total parenteral nutrition (TPN) to neonates is associated with the occurrence of cholestasis. Despite intensive research, the pathophysiological mechanisms have not been elucidated. In this review we describe the present insights into the risk factors for the development of TPN-associated cholestasis, the specific components or lack of components (deficiencies) in TPN that can cause cholestasis, the possible correlation with 'physiologic cholestasis of the neonate', which makes the infant more susceptible for potentially hepatotoxic compounds, and the transport systems in the liver cell membrane which are involved in bile formation. The hypothesis that 'cholestatic bile salts' play a role in the etiology of TPN-related cholestasis and the therapeutic options will be discussed.</p

The prognostic value of multivoxel magnetic resonance spectroscopy determined metabolite levels in white and grey matter brain tissue for adverse outcome in term newborns following perinatal asphyxia

Magnetic resonance spectroscopy can identify brain metabolic changes in perinatal asphyxia by providing ratios of metabolites, such as choline (Cho), creatine (Cr), N-acetyl aspartate (NAA) and lactate (Lact) [Cho/Cr, Lact/NAA, etc.]. The purpose of this study was to quantify the separate white and grey matter metabolites in a slab cranial to the ventricles and relate these to the outcome. A standard 2D-chemical shift imaging protocol was used for measuring a transverse volume of interest located cranial to the ventricles allowing for direct comparison of the metabolites in white and grey matter brain tissue in 24 term asphyxiated newborns aged 3 to 16 days. Cho, NAA and Lact showed significant differences between four subgroups of asphyxiated infants with more and less favourable outcomes. High levels of Cho and Lact in the grey matter differentiated non-survivors from survivors (P = 0.003 and P = 0.017, respectively). In perinatal asphyxia the levels of Cho, NAA and Lact in both white and grey matter brain tissue are affected. The levels of Cho and Lact measured in the grey matter are the most indicative of survival. It is therefore advised to include grey matter brain tissue in the region of interest examined by multivoxel MR spectroscopy. aEuro cent Magnetic resonance spectroscopy can identify brain metabolic changes in perinatal asphyxia. aEuro cent Choline and lactate levels in grey matter seem the best indicators of survival. aEuro cent Both grey and white matter should be examined during spectroscopy for perinatal asphyxia