Extrapyramidal syndrome in a newborn exposed to quetiapine in utero

*Correspondence: [e-mail].

Abstract

The use of atypical antipsychotics is increasingly common, including in the population of childbearing age. In this study, the authors intend to report changes in the neurological examination of newborns exposed to quetiapine in utero.

Case Presentation: A full-term male patient presented with sensory decrease and hypotonia at birth, requiring neonatal resuscitation maneuvers. Mother had a complete prenatal care, negative STORCHZ serology and no reports of intercurrences during pregnancy, except for a depressive episode treated with quetiapine, 300mg/day, throughout pregnancy. The patient was born with an Apgar score of 1/3/6, cord blood gas analysis within the normal range. Shortly after birth, he evolved with the need for admission to the neonatal ICU and subsequent orotracheal intubation due to sensory decrease. He remained hemodynamically stable, without the need for vasoactive drugs. The neurological examination showed extrapyramidal signs, such as plastic hypertonia, cogwheel rigidity and trismus. Cerebrospinal fluid was collected, and a tomography of the skull was performed, both normal. EEG presented with focal alterations in the right temporal region. He did not present seizures. The patient evolved with improvement of extrapyramidal symptoms from the fourth day of life, but these remained until the seventh day. Cranial magnetic resonance imaging showed no alterations. He was discharged from the hospital with 14 days of life, asymptomatic.

Discussion: The use of atypical antipsychotics by pregnant women may increase the risk of respiratory dysfunction, extrapyramidal syndrome and withdrawal syndrome in the newborn. Symptoms in the newborn may include agitation, eating disorder, hypertonia or hypotonia, respiratory distress, drowsiness, and tremor, and these effects may be self-limiting or require hospitalization. Evidence regarding fetal risk is limited and, so far, it is not possible to state whether maternal use of antipsychotics increases the risk of fetal malformations. There is no description of the duration of neurological symptoms secondary to the use of maternal quetiapine in newborns.

Final Comments: More studies are needed on the maternal use of atypical antipsychotics and it's effect in fetuses and newborns, since the available studies are still unable to define the safety of using these medications during pregnancy. Treatment and choice of medication should be individualized, weighing the maternal-fetal risk-benefit.

Publication History

Article published online:
12 May 2025