Neonatal admission after lithium use in pregnant women with bipolar disorders 109 Psychotropic medication other than lithium was used frequently in both groups (54.8% in lithium-exposed and 58.6% in non-lithium exposed neonates). Nine out of 42 lithium-exposed neonates were also exposed to antipsychotics (21.4%), four to serotonergic antidepressants (9.5%) and eight neonates to a combination of psychotropic medication (19.0%). In the non-lithium exposed neonates, antipsychotics (as monotherapy) were most frequently reported during pregnancy (25.3%), followed by serotonergic antidepressants (as monotherapy) in four cases (5.3%) and 13 neonates were exposed to a combination of psychotropic medication (17.3%). Type of BD differed between groups (with more type-I in the lithium-exposed group), all other characteristics were comparable between mothers. Admission to a neonatal ward with monitoring and adverse neonatal outcomes up to 28 days postpartum. Overall admission rate to a neonatal ward with monitoring was 19%, with a median duration of 3 days, see Table 5.2. Lithium-exposed neonates had a significantly higher birth weight (p = 0.040) and birth weight percentile (p = 0.021) than non-exposed neonates. There was no significant difference in admission rate to a neonatal ward with monitoring between lithiumexposed and non-lithium exposed neonates when estimated using a Chi2 test (OR 0.80, 95% CI 0.25–2.34, p = 0.844), a logistic regression analysis without any covariates (OR 0.80, 95% CI 0.28–2.09, p = 0.658) and after adjustment for ‘other psychotropic medication than lithium’ (OR 0.75, 95% CI 0.26–1.99, p = 0.671). A posthoc sensitivity analysis was performed to assess neonatal admission for neonates exposed to lithium in the third trimester of pregnancy (n = 41) versus neonates not exposed to lithium in the third trimester of pregnancy (n = 76) (OR 0.84, 95% CI 0.26–2.45, p = 0.808 using a Chi2 test). Figure 5.1 demonstrates reasons for admission to a neonatal ward with monitoring in both lithium-exposed and non-lithium exposed neonates, in addition to other psychotropic medication used in neonates with complications. One serious adverse outcome possibly related to lithium exposure was observed: a case of atrium flutter that required adenosine treatment. Three lithium-exposed neonates had glandular hypospadias, as opposed to four congenital malformations in the non-lithium exposed neonates (congenital foot deviation, polydactyly, ventricular septal defect, and central congenital hypothyroidism). Two lithium-exposed neonates were readmitted to a neonatal ward with monitoring within 28 days postpartum (the neonate with atrial flutter for relocation from an academic centre and one neonate with progressive posthemorrhagic hydrocephalus) and four non-lithium exposed neonates were readmitted (one with congenital hypothyroidism and adrenal
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