P A Dargaville1, N T Campbell. 1. Department of Neonatology, Royal Children's Hospital, Melbourne, Australia.
Abstract
OBJECTIVE: To document the short- and long-term effects of accidental administration of ergometrine in adult dosage to the newborn infant. METHODS: The case records of all infants admitted to the Royal Children's Hospital (RCH) since 1970 with a diagnosis of acute ergometrine overdose were reviewed, and details of the acute symptomatology, management, and the neurodevelopmental outcome at follow-up were noted. Similar information was obtained, where available, from previous case reports, and from two major drug information services. Additionally, data relating to administration of uterotonic agents and vitamin K were collected from tertiary perinatal centres around Australia. RESULTS: Seven cases of neonatal ergometrine overdose were identified at RCH. The major features of the acute toxicity syndrome were: encephalopathy (100% RCH cases, 79% combined cases); seizures (100%, 70%); peripheral vascular disturbances (100%, 83%); and oliguria (43%, 34%). Other important symptoms were hypoxaemia, hypertension and feed intolerance. 86% of RCH cases (72% overall) required ventilatory support. Virtually all symptoms resolved within 4 days, and 86% of RCH infants (86% all cases) were neurologically intact at the time of discharge. Long-term neurodevelopmental outcome was normal in 100% of RCH infants (n=6). All the perinatal centres surveyed give vitamin K in the labour ward soon after delivery, and 7 of 18 (39%) reported using Syntometrine (ergometrine 0.5 mg, Syntocinon 5 IU) routinely during the third stage of labour. Thus the circumstances in which ergometrine overdose can occur still exist in many labour wards around the country. CONCLUSIONS: Despite the catastrophic initial presentation, the long-term prognosis after neonatal ergometrine overdose appears to be favourable. To prevent further cases of this life-threatening drug error, we recommend that administration of vitamin K be deferred until just prior to, or shortly after, transfer of the newborn infant to the postnatal ward.
OBJECTIVE: To document the short- and long-term effects of accidental administration of ergometrine in adult dosage to the newborn infant. METHODS: The case records of all infants admitted to the Royal Children's Hospital (RCH) since 1970 with a diagnosis of acute ergometrineoverdose were reviewed, and details of the acute symptomatology, management, and the neurodevelopmental outcome at follow-up were noted. Similar information was obtained, where available, from previous case reports, and from two major drug information services. Additionally, data relating to administration of uterotonic agents and vitamin K were collected from tertiary perinatal centres around Australia. RESULTS: Seven cases of neonatal ergometrineoverdose were identified at RCH. The major features of the acute toxicity syndrome were: encephalopathy (100% RCH cases, 79% combined cases); seizures (100%, 70%); peripheral vascular disturbances (100%, 83%); and oliguria (43%, 34%). Other important symptoms were hypoxaemia, hypertension and feed intolerance. 86% of RCH cases (72% overall) required ventilatory support. Virtually all symptoms resolved within 4 days, and 86% of RCHinfants (86% all cases) were neurologically intact at the time of discharge. Long-term neurodevelopmental outcome was normal in 100% of RCHinfants (n=6). All the perinatal centres surveyed give vitamin K in the labour ward soon after delivery, and 7 of 18 (39%) reported using Syntometrine (ergometrine 0.5 mg, Syntocinon 5 IU) routinely during the third stage of labour. Thus the circumstances in which ergometrineoverdose can occur still exist in many labour wards around the country. CONCLUSIONS: Despite the catastrophic initial presentation, the long-term prognosis after neonatal ergometrineoverdose appears to be favourable. To prevent further cases of this life-threatening drug error, we recommend that administration of vitamin K be deferred until just prior to, or shortly after, transfer of the newborn infant to the postnatal ward.