Table 4 Description of infants with possibly severe symptoms and/or high lithium levels
ID, (HEG/ LEG) | Lithium concentration (meq/l) | Breastfeeding | Infant symptoms | Other psychotropic drugs | Potential cause of pathology | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
MS | UC | IS | FU | MS-FU | At birth | At follow-up | At birth | At follow-up | |||
A (HEG) | 0.8 | 0.9 | 0.6 | 0.7 | 0.6 | Part | Part | Mild prematurity, large for gestational age, need for CPAP for one day. Initial weight loss of 15% | Poor weight gain at 11 days of age, recommended to increase formula | SSRI, anxiolytics | Combination of exposure to lithium and other drugs, lower kidney function due to prematurity and dehydration due to large initial weight loss |
B (HEG) | 0.8 | 0.9 | 0.7 | 1.2 | – | Part | Part | Found cyanotic in the bed at maternity ward at 2 days of age but recovered without respiratory support. Observed for 2 days at NICU | No clinical symptoms but advised to stop breastfeeding due to high lithium concentration at 29 days of age | Anxiolytics when needed | Combination of pre- and postnatal exposure together with some unknown inborn fragility in the infant causing both the cyanotic spell and the high lithium concentration at follow-up? |
C (HEG) | 1.5 | 1.0 | 1.0 | 0.2 | 0.7 | Excl | Excl | Jittery at birth, blood glucose checked, normal. Elevated plasma creatinine level of 84 μmol/l at 48 h of age | Normalized plasma creatinine, 48 μmol/l, but jaundiced, tired and poor weight gain at 9 days of age | SSRI, central stimulants, anxiolytics | Toxic maternal serum lithium concentration and potentially maternal dehydration causing increased infant creatinine level at birth. However, the effects at follow-up might rather have been caused by the polypharmacy |
D (HEG) | 0.9 | 1.2 | – | 0.1 | – | Excl | Excl | No clinical symptoms at birth | No clinical symptoms at 26 days of age | Antipsychotics | High infant serum concentration at birth caused by high intrauterine exposure, without any clinical consequences and good clearance at follow-up |
E (LEG) | 0.5 | 0.5 | 0.4 | < 0.05 | 0.6 | Excl | Part | Jittery at birth, blood glucose checked × 3, normal | Tired with poor weight gain at 19 days of age, recommended to introduce formula | Anxiolytics | Jitteriness and poor weight gain may have been caused by the intrauterine lithium exposure as well as the polypharmacy |
F (LEG) | 0.4 | 0.3 | 0.4 | 0.1 | 0.5 | Part | Part | Cyanotic with respiratory distress at 25 min of age. Admitted to NICU, treated with CPAP for 1 day. Elevated thyroid hormone level, 47 pmol/l | Poor weight gain at 12 days of age. Normalized thyroid levels | SSRI, antipsychotics | Both the need for respiratory support at birth and the poor weight gain may be effects of polypharmacy rather than lithium exposure only |
G (LEG) | 0.2 | – | 0.2 | < 0.05 | 0.1 | Part | Part | Need for CPAP briefly from one minute of age, no need for admission to NICU | No symptoms at the follow-up at eight days of age | Central stimulants | Need for respiratory support initially likely to be related to the instrumental delivery rather than exposure to low dose lithium |
H (LEG) | 0.2 | 0.2 | – | 0.1 | – | Excl | Excl | Pale and hypotonic shortly after birth. Receives treatment with CPAP briefly, after that no need for admission to NICU | No symptoms at the follow-up at 29 days of age | – | Short need for respiratory support due to other factors than the low exposure to lithium |