Monday, March 17, 2008

Search challenge 3

For this week, we'll tackle a pediatric question.

The question: For babies exposed to drugs in utero, particularly opioids, should breastfeeding be encouraged while the mother is on a methadone drug cessation program?

Share your questions and strategies in the comments!



Blogger margaret said...

(("Milk, Human"[MAJR]) AND ("Methadone"[MAJR])) AND ("Infant, Newborn"[MeSH Terms])

this was the simplest strategy


Jansson LM, Choo R, Velez ML, Harrow C, Schroeder JR, Shakleya DM, Huestis MA.
Methadone maintenance and breastfeeding in the neonatal period.
Pediatrics. 2008 Jan;121(1):106-14.
PMID: 18166563 [PubMed - indexed for MEDLINE]

Jansson LM, Choo RE, Harrow C, Velez M, Schroeder JR, Lowe R, Huestis MA.
Concentrations of methadone in breast milk and plasma in the immediate perinatal period.
J Hum Lact. 2007 May;23(2):184-90.
PMID: 17478871 [PubMed - indexed for MEDLINE]

Ballard JL.
Treatment of neonatal abstinence syndrome with breast milk containing methadone.
J Perinat Neonatal Nurs. 2002 Mar;15(4):76-85. Review.
PMID: 11911622 [PubMed - indexed for MEDLINE]

Begg EJ, Malpas TJ, Hackett LP, Ilett KF.
Free in PMC
Distribution of R- and S-methadone into human milk during multiple, medium to high oral dosing.
Br J Clin Pharmacol. 2001 Dec;52(6):681-5.
PMID: 11736879 [PubMed - indexed for MEDLINE]

Wojnar-Horton RE, Kristensen JH, Yapp P, Ilett KF, Dusci LJ, Hackett LP.
Free in PMC
Methadone distribution and excretion into breast milk of clients in a methadone maintenance programme.
Br J Clin Pharmacol. 1997 Dec;44(6):543-7.
PMID: 9431829 [PubMed - indexed for MEDLINE]

Blinick G, Inturrisi CE, Jerez E, Wallach RC.
Methadone assays in pregnant women and progeny.
Am J Obstet Gynecol. 1975 Mar 1;121(5):617-21.
PMID: 1115163 [PubMed - indexed for MEDLINE]


3/18/2008 7:25 AM  
Blogger dewey_decimal said...

Don't forget to consult LactMed for questions relating to drugs and breastfeeding: From the first part of the drug summary for Methadone:

"Summary of Use during Lactation:
When methadone is used as maternal maintenance therapy, breastfeeding may decrease neonatal withdrawal symptoms in infants who were exposed in utero. However, because methadone is transferred to breastmilk in only small amounts, a breastfed newborn or infant may require treatment for withdrawal.[1][2][3][4][5] The amount of methadone in breastmilk from a mother on methadone maintenance was calculated to be insufficient to warrant lowering the dosage of diluted tincture of opium given to the newborn to mitigate methadone withdrawal.[6] Initiation of methadone, or increasing the maternal dosage to greater than 100 mg daily therapeutically or by abuse while breastfeeding poses a greater risk of sedation and respiratory depression in the breastfed infant. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately."

3/18/2008 9:15 AM  

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