Case Report Neonatal withdrawal syndrome after chronic maternal consumption of 4-methylethcathinone Simona Pichini a, *, Maria Concetta Rotolo a , Jordi Garcı ´a b , Noelia Girona c , Lorna Leal c , Oscar Garcı ´a-Algar b , Roberta Pacifici a a Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanita ´, Rome, Italy b Unitat de Recerca Infa `ncia i Entorn (URIE), Paediatric Service, Institut Mar d’Investigacions Me `diques (IMIM), Barcelona, Spain c CAS Baluard, Age `ncia de Salut Pu ´blica de Barcelona Service, Managed by Associacio ´ Benestar i Desenvolupament, Barcelona, Spain 1. Introduction New psychoactive substances with stimulant or hallucinogenic properties became increasingly popular among recreational drug users in recent years [1,2] with no negligible diffusion into drug user population [3]. In particular, an increase in the consumption of synthetic cathinones (e.g. mephedrone, methylone, methyle- nedioxypryrovalerone, etc.) with sympathomimetic action and hallucinogenic properties was observed [4]. These substances, commonly known as ‘‘bath salts’’ are beta-keto analogs of the natural cathinone found in Catha edulis (khat) shrub of African origin [4]. In addition to their stimulant effects due to the release of serotonin and dopamine and the inhibition of their reuptake, their adverse effects are due to symphathomimetic toxicity [5]. Tachycardia, anxiety, hypertension, dizziness and also neuropsy- chatric effects such as paranoia and psychosis were reported [4,5]. These substances are illegal in US but unregulated in some European countries, and can be obtained in ‘‘smart shops’’, smoke shops, gas stations and web sites where they can be bought and received anonymously avoiding normal law controls [3,6]. It was shown cathinone derivatives to be present in the Spanish drug market in recent years [7]. We here report a case of a neonatal withdrawal syndrome in a baby born in Barcelona, Spain to a woman who was a chronic user of 4-methylethcathinone (4-MEC, 4-methyl-N-ethylcathinone). 2. Case report A male newborn presented with increased jitteriness and irritability, highpitched cry, hypertonia in the limbs and brisk Forensic Science International 245 (2014) e33–e35 A R T I C L E I N F O Article history: Received 18 August 2014 Received in revised form 11 October 2014 Accepted 14 October 2014 Available online 24 October 2014 Keywords: 4-Methylethcathinone Hair testing Meconium Neonatal withdrawal syndrome A B S T R A C T Synthetic cathinones have been markedly present in the Spanish drug market in recent years. These substances can be easily obtained in ‘‘smart shops’’, smoke shops, gas stations and web sites where they can be bought and received anonymously avoiding normal law controls. For the first time we present a case of a neonatal withdrawal syndrome in a baby born to a woman who was a chronic consumer of 4-methylethcathinone. The newborn presented with increased jitteriness and irritability, highpitched cry, hypertonia in the limbs and brisk tendon reflexes. 4-Methylethcathinone was identified and quantified by liquid chromatography tandem mass spectrometry in the four subsequent 3 cm segments of maternal hair (4.3, 4.0, 4.0 and 3.9 ng/mg hair starting from most proximal segment) accounting for maternal consumption during the whole pregnancy and before and in neonatal meconium (0.7 ng/g) confirming fetal exposure during intrauterine life. Methadone and its metabolite were also measured in maternal and neonatal matrices. Counseling pregnant women and women who may become pregnant on the consequences of fetal drug exposure to new designer drugs like 4-methylethcathinone is critical to preventing poor neonatal outcomes. This case report is informative to those studying designer drugs and those clinically involved with pregnant women abusing psychoactive substances. ß 2014 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanita `, V.le Regina Elena 299, 00161 Rome, Italy. Tel.: +39 06 49906545; fax: +39 06 49902016. E-mail address: simona.pichini@iss.it (S. Pichini). Contents lists available at ScienceDirect Forensic Science International jou r nal h o mep age: w ww.els evier .co m/lo c ate/fo r sc iin t http://dx.doi.org/10.1016/j.forsciint.2014.10.027 0379-0738/ß 2014 Elsevier Ireland Ltd. All rights reserved.