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
