2025 – PAGE 246 – PHARMACOLOGY & DRUG PEARLS
HEROIN EXPOSURE
There is often intrauterine fetal demise (IUFD) from heroin exposure. If not, look for seizures, tremors, irritability, etc.
PEARL: Heroin induces lung maturity, so if the baby survives, s/he is less likely to have lung disease.
METHADONE EXPOSURE
Newborn babies with a history of methadone exposure can have seizures. Symptoms may not present for up to 4–6 weeks!
LITHIUM EXPOSURE
Lithium exposure can cause Ebstein’s anomaly. Lithium TOXICITY (in an overdose) can cause heart arrhythmias including heart blocks.
MNEMONIC: (VIDEO) Instead of lithium and Ebstein, if you can somehow associate lithium and EINSTEIN (since they sound alike), you’ll be set. Now imagine EINSTEIN putting LITHIUM fuel in the flux capacitor of the Back to the Future car. (For you junkies, yes, I know it’s actually plutonium.) Here’s a great clip. In it, the doc looks like Einstein, and the dog’s name IS Einstein. www.pbrlinks.com/LITHIUMEXPOSURE1
(DOUBLE TAKE) MAGNESIUM SULFATE INFUSION
Magnesium Sulfate Infusions (for tocolysis or preeclampsia) can result in severe hypocalcemia. Treat with calcium gluconate, but keep in mind that they may not respond as quickly as would normally be expected. So, if you are given a vignette about a hypocalcemic baby that is not responding to calcium gluconate, consider magnesium tocolysis as the etiology.
WARFARIN EXPOSURE
Warfarin (coumadin) exposure can result in FETAL WARFARIN SYNDROME. Look for a flat nasal bridge, a hypoplastic nose (possible upper airway obstruction), hypoplastic distal phalanges, and “stippling of the vertebrae.”
ANTI-SEIZURE MEDICATION EXPOSURE
As a general rule for pre-natal exposure to antiseizure medications, look for cardiac defects, especially Tetralogy of Fallot, Aortic Stenosis, and Pulmonary Stenosis. Certain medications can also cause MICROCEPHALY, anticonvulsant facies (broad nasal bridge, small/anteverted nostrils, “angry” look), intrauterine growth retardation (IUGR), and fingernail hypoplasias.
MNEMONIC: To remember the possible cardiac defects, think about what a seizure sounds like: TAP TAP TAP!!! As the patient seizes back and forth on a wooden floor, you notice bright red blood on the floor in the shape of a red HEART. KEY: TAP = TOF, AS, and PS.
PHENYTOIN EXPOSURE
Phenytoin exposure can cause FETAL HYDANTOIN SYNDROME (AKA PHENYTOIN SYNDROME). Look for finger and nail hypoplasia, a wide anterior fontanelle, prominent metopic ridge (bony ridge secondary to abnormal closure of fontanelle), wide-spaced eyes, broad/depressed nasal bridge, short upturned nose, and/or cleft lip/palate.
IMAGE: www.pbrlinks.com/PHENYTOINEXPOSURE1
MNEMONIC: Imagine a baby sucking on “PHUNNY-TOES” and fingernails that fit very comfortably into a baby’s CLEFT LIP/PALATE.