Disclosures: Marianne A. Mousigian, MD: No financial relationships or conflicts of interest

Case Description: Patient’s mother took oral baclofen during pregnancy for spasticity associated with a remote cervical spinal cord injury. Delivery occurred via C-section due to maternal autonomic dysreflexia and breech presentation. The neonate was started on baclofen 0.125 mg/kg/dose every 6 hours beginning several hours after birth due to concern for neonatal baclofen withdrawal. A gradual taper was initiated on day of life five after undergoing long term EEG monitoring without evidence of further events or seizures. Dose was reduced to 0.125 mg/kg/dose every eight hours on days 5-7 of life, 0.125 mg/kg/dose every twelve hours on days 8-10 of life, and 0.125 mg/kg/dose daily on days 11-13 of life before discontinuation. The patient’s symptoms were monitored with the Finnegan Neonatal Abstinence Scale. Scores ranged from 0 to 6 due to signs including mild tremors, regurgitation, poor feeding, sneezing, impaired sleep, fever, and hyperactive Moro Reflex. These scores decreased and were consistently 0 by day of life nine.

Setting: Tertiary care children’s hospital.

Patient: A neonate with intrauterine baclofen exposure born at 34 3/7 weeks had a 2-minute episode of posturing with extended arms and legs at 15 minutes of life. Assessment/

Results: The patient was admitted for monitoring until day of life fourteen in the setting of prematurity and concern for baclofen withdrawal. Full resolution of withdrawal symptoms occurred. The General Movements Assessment revealed poor repertoire of movement for age which could be attributed to prematurity. The infant was otherwise neurologically intact.

Discussion: There are few cases in the literature discussing neonatal baclofen withdrawal and suggested management.

Conclusion: Baclofen, a FDA Pregnancy Category C drug, is often continued throughout pregnancy for management of spasticity. The possibility of neonatal baclofen withdrawal may not be recognized; these neonates require close monitoring and may require a baclofen taper to prevent withdrawal symptoms.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/neonatal-baclofen-withdrawal-following-intrauterine-exposure-a-case-report/