Cerebral seizures and EEG abnormalities caused by neonatal nicotine withdrawal
Aims: Nicotine is the most frequently used drug during pregnancy. Well-known consequences for the child are preterm birth and intrauterine growth retardation. In addition a possible teratogenic effect on the child and an increased risk for SIDS are being discussed. After birth these children are prone to suffer from irritability whereas a severe neonatal withdrawal syndrome as after maternal opioid abuse is rarely caused by maternal abuse of nicotine. In this context, cerebral seizures of newborns have not yet been reported. In adults, however, EEG abnormalities have been described in the context of nicotine withdrawal. Here, we present a newborn with seizures and interictal EEG abnormalities that were diagnosed in the course of a neonatal nicotine withdrawal. When withdrawal symptoms subsided EEG normalized and seizures stopped.
Case report: A mature newborn with adequate weight gain was treated in our clinic due to respiratory distress and infection. The mother admitted to have smoked more than 40 cigarettes per day during pregnancy. Soon after birth the child showed extreme irritability including screaming attacks, increased tonicity, stronger reflexes and tremors. It was therefore necessary to sedate the child with chloral hydrate. On the 9th and 10th day we recorded repeated tonic-clonic seizures. Twice intravenous phenobarbital had to be administered to terminate the seizures. On the 10th day the EEG revealed a right temporal sharp wave focus. Cerebral ultrasound, MRI and comprehensive laboratory studies to rule out electrolyte shifts, infections and metabolic diseases were all without any pathological findings. Parallel to the gradual improvement of irritability, cerebral seizures subsided and the described EEG abnormalities could no longer be detected.
Conclusion: Our observations in a newborn with a strong maternal nicotine abuse during pregnancy suggest that a neonatal withdrawal syndrome can be caused by nicotine. Although the accidental combination of a withdrawal syndrome and benign neonatal seizures cannot be excluded the described course and corroborating observations in adults indicate that EEG abnormalities and cerebral seizures might be caused by neonatal nicotine withdrawal.