Methadone Maintenance and Breastfeeding in the Neonatal Period

Jansson, Lauren M.; Choo, Robin E.; Vélez, Martha L.; Harrow, Cheryl; Schroeder, Jennifer R.; Shakleya, Diaá M.; Huestis, Marilyn A.

doi:10.1542/peds.2007-1182

Cited by 129 publications

(98 citation statements)

References 34 publications

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“…Several studies of infants fed with milk from mothers on methadone maintenance therapy 17,18,26 suggest reduced incidence and severity of NAS. Our study data affirm that the magnitude of the favorable response correlates with the volume of MBM ingested as a proportion of total intake.…”

Section: Discussionmentioning

confidence: 99%

Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome

Isemann¹,

Meinzen‐Derr

Akinbi

2010

J Perinatol

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Objective: To identify maternal and neonatal factors that impact response to methadone therapy for neonatal abstinence syndrome.Study Design: This is a retrospective review of 128 infants that received pharmacotherapy for opiate withdrawal to identify factors associated with favorable response to methadone therapy. Maternal and neonatal data were analyzed with univariate statistics and multivariate logistic regression.Result: Maternal methadone maintenance dose during pregnancy correlated with length of stay (P ¼ 0.009). There was an inverse correlation between the amount of mother's breast milk ingested and length of stay (b ¼ À0.03, P ¼ 0.02). Methadone was initiated later, tapered more rapidly and was more successful as monotherapy in preterm infants. Five percent of infants were admitted to hospital again for rebound withdrawal following reduction of breast milk intake. Conclusion:Severity of neonatal abstinence syndrome may be mitigated by titrating methadone to the lowest effective dose during pregnancy and by encouraging breast milk feeds, which should be weaned gradually.

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Section: Discussionmentioning

confidence: 99%

Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome

Isemann¹,

Meinzen‐Derr

Akinbi

2010

J Perinatol

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“…157 Multiple studies have validated the finding that breast milk contains only minimal quantities of methadone and buprenorphine. [158][159][160] Obstetricians and lactation specialists also have endorsed breastfeeding among opioidaddicted mothers. 161,162 Subsequent to these recommendations, some improvements in breastfeeding practices have been noted.…”

Section: Breastfeedingmentioning

confidence: 99%

Neonatal Abstinence Syndrome

2014

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Neonatal abstinence syndrome (NAS) is a result of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. Withdrawal from licit or illicit substances is becoming more common among neonates in both developed and developing countries. NAS continues to be an important clinical entity throughout much of the world. NAS leads to a constellation of signs and symptoms involving multiple systems. The pathophysiology of NAS is not completely understood. Urine or meconium confirmation may assist the diagnosis and management of NAS. The Finnegan scoring system is commonly used to assess the severity of NAS; scoring can be helpful for initiating, monitoring, and terminating treatment in neonates. Nonpharmacological care is the initial treatment option, and pharmacological treatment is required if an improvement is not observed after nonpharmacological measures or if the infant develops severe withdrawal. Morphine is the most commonly used drug in the treatment of NAS secondary to opioids. An algorithmic approach to the management of infants with NAS is suggested. Breastfeeding is not contraindicated in NAS, unless the mother is taking street drugs, is involved in polydrug abuse, or is infected with HIV. Future studies are required to assess the long-term effects of NAS on children after prenatal exposure.

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“…53,54 Plasma concentrations in infants are also low (less than 3% of maternal trough concentrations) during the neonatal period and up to 6 months postpartum. 55,56 For these reasons, guidelines from the Academy of Breastfeeding Medicine encourage breastfeeding for women treated with methadone who are enrolled in methadone-maintenance programs. 48 Buprenorphine is excreted into human milk and achieves a level similar to that in maternal plasma.…”

Section: Drugs For Smoking Cessation or To Treat Substance Abuse/ Alcmentioning

confidence: 99%

The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics

Sachs¹

2013

Pediatrics

403

198

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Many mothers are inappropriately advised to discontinue breastfeeding or avoid taking essential medications because of fears of adverse effects on their infants. This cautious approach may be unnecessary in many cases, because only a small proportion of medications are contraindicated in breastfeeding mothers or associated with adverse effects on their infants. Information to inform physicians about the extent of excretion for a particular drug into human milk is needed but may not be available. Previous statements on this topic from the American Academy of Pediatrics provided physicians with data concerning the known excretion of specific medications into breast milk. More current and comprehensive information is now available on the Internet, as well as an application for mobile devices, at LactMed (http://toxnet.nlm.nih.gov). Therefore, with the exception of radioactive compounds requiring temporary cessation of breastfeeding, the reader will be referred to LactMed to obtain the most current data on an individual medication. This report discusses several topics of interest surrounding lactation, such as the use of psychotropic therapies, drugs to treat substance abuse, narcotics, galactagogues, and herbal products, as well as immunization of breastfeeding women. A discussion regarding the global implications of maternal medications and lactation in the developing world is beyond the scope of this report. The World Health Organization offers several programs and resources that address the importance of breastfeeding (see http://www.who.int/topics/breastfeeding/en/).

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Methadone Maintenance and Breastfeeding in the Neonatal Period

Abstract: Results contribute to the recommendation of breastfeeding for methadone-maintained women.

Cited by 129 publications

References 34 publications

Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome

Maternal and neonatal factors impacting response to methadone therapy in infants treated for neonatal abstinence syndrome

Neonatal Abstinence Syndrome

The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics

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