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.
Subject(s)
Ergonovine/poisoning , Medication Errors , Oxytocics/poisoning , Drug Overdose , Female , Humans , Infant, Newborn , Male , Prognosis , Vitamin K/administration & dosageSubject(s)
Ergonovine/poisoning , Infant, Newborn, Diseases/chemically induced , Oxytocin/poisoning , Pulmonary Edema/chemically induced , Accidents , Humans , Infant, Newborn , Infant, Newborn, Diseases/mortality , Infant, Newborn, Diseases/pathology , Lung/pathology , Male , Pulmonary Edema/mortality , Pulmonary Edema/pathologyABSTRACT
The clinical course is described of an infant who accidentally received an adult dose of Syntometrine (synthetic oxytocin + ergometrine) at delivery. The infant soon became ill with convulsions and ventilatory failure, and later with water intoxication. Similar reported cases are reviewed and recommendations are given for the management of future cases.
