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.
