Benzodiazepines are one of the most frequently prescribed psychotropic drugs during pregnancy. Despite the fact that these drugs have been in use for a long time, there is still debate about the safety for the developing fetus and neonate. We present a case of a newborn with an apparent life-threatening event shortly after birth following maternal temazepam use during labour and advise to be reserved in prescribing any dose of any kind of benzodiazepine during labour.
Benzodiazepines are one of the most frequently prescribed psychotropic drugs during pregnancy [
A 38-week-old female neonate, born via a spontaneous vaginal delivery guided by a midwife at home, was presented to our Neonatal Intensive Care Unit (NICU) after an episode of apnea, bradycardia, and hypotonia one hour postpartum. The mother, a healthy 30-year-old gravida 3 para 1 had an uneventful pregnancy during which she did not use any medication. Cervix dilation progressed slowly and the midwife was prescribed temazepam 20 mg to prevent maternal exhaustion in the first stage of labour. However, in contrary to what was expected, labour progressed quickly and three and a half hours since temazepam ingestion mother gave birth to a female infant newborn. Apgar Scores 1 and 5 minutes after birth were both 10 out of 10. Birth weight was 3650 gram (+1 SD), length was 34 cm (+1 SD), and head circumference was 34 cm (−1 SD). Breastfeeding was initiated immediately after birth. One hour later the baby was found nonbreathing, pale, and hypotonic on mothers breast. The attending midwife initiated neonatal resuscitation. Chest compressions were started in combination with ventilation because of persisting bradycardia after inflation breaths. Heart frequency normalized and spontaneous breathing returned. She was intubated and transported by the mobile medical team to our hospital in stable condition. Neurologic examination at arrival at the NICU showed a normal muscle tone and symmetric movements of all limbs. Pupils were isocore and reactive to light. Sucking reflex was present, while grasp reflex was absent. Initial blood workup showed normal values for glucose and electrolytes but a venous serum lactate of 8.6 mmol/L. Capillary blood gas showed a pH of 7.35, pCO2 of 31 mmHg,
Cerebral function monitoring (CFM) of an infant newborn with an apparent life-threatening event following maternal temazepam use during labour. On
Benzodiazepines have hypnotic, anxiolytic, anticonvulsive, and muscle relaxant abilities. They are mainly used for sleeping and anxiety disorders. In addition, they are used as anticonvulsant and as hypnotic drug during medical treatment [
When benzodiazepines are used during the last trimester of pregnancy a floppy infant syndrome and withdrawal syndrome have been described [
This case presents a newborn with an apparent life-threatening event shortly after birth most probably caused by maternal temazepam use during labour. A single dose of 20 mg temazepam resulted in a supratherapeutic plasma level in the newborn. Since 20 mg temazepam is considered a small dose, we advise to be reserved in prescribing any dose of any kind of benzodiazepine during labour.
The authors declare that there is no conflict of interests regarding the publication of this paper.