Evidence map›Paper›PMID 38032417›Full record

ArticleInternational journal of bipolar disorders2023

High lithium concentration at delivery is a potential risk factor for adverse outcomes in breastfed infants: a retrospective cohort study.

Essi Whaites Heinonen, Katarina Tötterman, Karin Bäck, Ihsan Sarman, Lisa Forsberg, Jenny Svedenkrans

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in International journal of bipolar disorders, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.6field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 3 citations in OpenAlex.

  1. Review
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 1 country.

Essi Whaites HeinonenDepartment of Clinical Science, Intervention and Technology (CLINTEC), Div of Pediatrics, Karolinska Institutet, Blickagången 6A, 14157, Huddinge, Stockholm, Sweden. essi.heinonen@ki.se.
Katarina TöttermanSachs' Children's and Adolescents' Hospital, Stockholm, Sweden.
Karin BäckDepartment of Neonatology, St Goran Hospital, Stockholm, Sweden.
Ihsan SarmanDepartment of Clinical Science and Education Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden.
Lisa ForsbergDepartment of Clinical Science, Intervention and Technology (CLINTEC), Div of Pediatrics, Karolinska Institutet, Blickagången 6A, 14157, Huddinge, Stockholm, Sweden.
Jenny SvedenkransDepartment of Clinical Science, Intervention and Technology (CLINTEC), Div of Pediatrics, Karolinska Institutet, Blickagången 6A, 14157, Huddinge, Stockholm, Sweden.
Karolinska Institutet · SEKarolinska University Hospital · SESachs' Children and Youth Hospital · SESaint Göran Hospital · SE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNeonatal effects of late intrauterine and early postpartum exposure to lithium through mother's own milk are scarcely studied. It is unclear whether described symptoms in breastfed neonates are caused by placental lithium transfer or postnatal exposure to lithium through breastfeeding. We aimed to investigate lithium clearance and neonatal morbidity in breastfed infants with high versus low serum lithium concentrations at birth.

methodsThis retrospective study focused on breastfed infants to women treated with lithium during and after pregnancy, born between 2006 and 2021 in Stockholm, Sweden. Information on serum lithium concentrations and adverse neonatal outcomes was obtained from medical records. Neonatal symptoms and lithium clearance were compared between a high exposure group (HEG, lithium concentrations ≥ 0.6 meq/l) and a low exposure group (LEG, < 0.6 meq/l).

resultsA total of 25 infant-mother dyads were included. Median lithium serum concentration at birth was 0.90 meq/l in the HEG as compared with 0.40 meq/l in the LEG (p < 0.05). The difference was still significant at follow-up (0.20 meq/l vs 0.06 meq/l, p < 0.05), despite reduction in maternal dose. The rate of neonatal symptoms was 85.7% in HEG and 41.2% in LEG (p = 0.08) at birth and 28.6% vs 11.8% at follow-up (p = 0.55). Furthermore, 28.6% of infants in HEG were admitted to neonatal care, vs 5.9% in LEG (p = 0.19). Two infants in the HEG had therapeutic lithium levels at follow-up. All infants with symptoms at follow-up were either in the HEG or exposed to additional psychotropic medication.

conclusionsNeonatal symptoms are common after late intrauterine lithium exposure, however transient, treatable and mostly mild. In this study, a high lithium concentration at birth was a risk factor for an increased lithium level at follow-up. Polypharmacy may constitute an additional risk factor. This study suggests that the late intrauterine exposure to lithium might add to the adverse effects in lithium-exposed, breastfed infants. Consequently we recommend breastfed infants with therapeutic lithium concentrations at birth to be followed up promptly to avoid lithium toxicity.

Indexed as

Bipolar disorderBreastfeedingDrug concentrationsLactationLithiumNeonatal effectsPregnancyPsychiatry

Identifiers

PMID38032417
PMCPMC10689698
OpenAlexW4389178931

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.