Case Presentation: Patient 1:39 week gestation newborn male with a birth weight of 3521 grams. Prenatal course was overall uncomplicated. Mother was a 27 year old G2P2 woman who had used medical cannabis several times a week during pregnancy for PTSD, anxiety and headaches. No other non-prescribed substances were used and umbilical cord toxicology testing was negative for other substances except THC. Delivery was uncomplicated with APGARs of 8 and 9.At about 24 hours of life the newborn exhibited frequent disturbed and undisturbed jitteriness, fussiness, and mild hypertonia. These symptoms worsened by about 48 hours, but were slightly improved by 72 hours. The parents agreed to formula feeding only. There was a total 6% weight loss from birth by day three. Baby was discharged at day three with close outpatient follow-up and no known adverse outcomes. Patient 2:39 week gestation newborn male with a birth weight of 3527 grams. Mother was a 27 year old G3P3 woman whose pregnancy course was complicated by nausea for which mother used daily cannabis and nightly diphenhydramine. Toxicology screen was positive for urine cannabinoids. Labor was complicated by a prolapsed umbilical cord and emergency C-section. Baby had APGARs of 2, 9, and 9 with resuscitation using CPAP briefly. At 24 hours of life the patient was noted to be tumultuous, jittery, and fussy despite being swaddled and would only console while skin to skin on mom. On exam there was mild hypotonia. Symptom intensity increased the second day of life, with the development of a new head lag. Excessive rooting and suck behavior was present during examinations. There was a total 9% weight loss from birth by day three. Baby was breast fed with formula supplementation. Mother stated she would abstain from cannabis while breastfeeding. Baby was discharged at day three with close outpatient follow-up and no known adverse outcomes. It was thought that the symptoms above were due to a combination of cannabis and diphenhydramine withdrawal.
Discussion: Both of these newborns displayed signs of cannabis withdrawal after frequent cannabis use by the mothers during pregnancy. Their primary findings were jitteriness and irritability that peaked within the first 72 hours. The first newborn had hypertonia, and the second newborn had hypotonia. Both had moderate weight loss that was managed with close monitoring and feeding support.In the literature, there is increasing evidence for cannabis use during pregnancy affecting the fetus. Long term effects for the child include aggressive behavior and deficits in frontal lobe executive function, attention, and focus observed from 18 months to 22 years old. There is less known about frequent cannabis use during pregnancy causing acute withdrawal in the newborn period. The most noted findings of fetal exposure to cannabis is reduced birth weight from the control group. Neurobehavioral changes have also been observed in the first week of life. These include increase in tremors and startles as seen in our cases, and decreased visual habituation and visual responses in the first week of life.
Conclusions: We describe two newborns here that had acute cannabis withdrawal with primary findings jitteriness and irritability that peaked within the first 72 hours of life. There is established evidence for cannabis use during pregnancy affecting the fetus but there is less known about frequent cannabis use during pregnancy causing acute withdrawal in the newborn period. More studies describing cannabis withdrawal would be beneficial in the management of these newborns.