Administering a local anesthetic to the mother prior to delivery can result in a transient intoxication of the neonate.


Situation: administration of a local anesthetic (injection, topical cream) to the mother prior to delivery, usually the perineum before an episiotomy


Clinical findings:

(1) often follows an uncomplicated vaginal delivery with high Apgar scores

(2) sudden onset of symptoms

(3) apnea

(4) cardiac arrhythmias (bradycardia, tachycardia)

(5) hypotonia

(6) seizures

(7) dilated pupils fixed to light or oculocephalic reflex (doll's eyes)


Laboratory findings:

(1) no or slight acidosis

(2) presence of local anesthetic and metabolites in the neonatal urine for several days after delivery


Differential diagnosis:

(1) perinatal asphyxia

(2) neonatal sepsis

(3) metabolic encephalopathy


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