Table 3.

Recommendations regarding observation and treatment of Poor Neonatal Adaptation (PNA)

General recommendations

In otherwise healthy infants routine additional laboratory tests in order to exclude possible neonatal complications are not required.

Observation at the maternity ward is preferred. Only when PNA symptoms are severe, admittance to the Neonatal Care Unit is necessary.

Discourage the use of illicit drugs and alcohol since these substances also cause PNA.

An observation period of 48–72 hours is sufficient when no PNA symptoms occur.

When PNA symptoms are present observe the infant until the PNA symptoms are fully resolved.

The Finnegan scoring list has to be administered every 8 hours by trained nurses.

In case of a score of 8 or higher this has to be intensified to every 2 hours.

Interpretation of the score has to be carried out by the pediatrician.

In case of debate on the origin of presenting symptoms other diagnoses such as infection, metabolic or neurologic problems, hyper viscosity, and excitation syndromes like small for gestational age have to be excluded.

In case of any doubt on possible intoxications during pregnancy toxicological urine screening is indicated.

Supporting measures such as frequent small feedings on demand, swaddling and increase of skin to skin contact with mother is mostly sufficient.

When there is severe PNA and supporting measures are not sufficient, phenobarital is a safe therapeutic option. When using the Finnegan scoring list ≥2 scores of 8 or higher in between 2 hours is an indication of pharmacotherapy.

Drug specific recommendations

After exposure to lithium during pregnancy, discontinue when the patient is in partu and re-instate directly post delivery.

The dosage of antidepressants seems not related to the risk of development of PNA. Therefore, lowering the dosage is not useful in order to prevent PNA.

Encourage breastfeeding after exposure to SSRIs, mirtazapine or venlafaxine, since this probably reduces the risk of PNA.