Postnatal weight loss in substitute methadone-exposed infants: implications for the management of breast feeding

Abstract

It is widely accepted that maternal drug-exposed infants demonstrate excessive early weight loss, but this has not previously been quantified. Among 354 term, substitute methadone-exposed infants, median maximal weight losses were 10.2% and 8.5% for breast- and formula-fed infants, respectively (p=0.003). Weight loss was less in small for gestational age compared to appropriately grown infants (p<0.001). There was no association between maximal weight loss and plasma sodium concentration (p=0.807). Relative to non-drug exposed infants, weight loss was more marked in formula-fed infants, 48% of whom demonstrated weight loss in excess of the 95th centile (compared to 23% of exclusively breastfed infants; p<0.001). Median weight loss nadir was on day 5, excepting those infants exclusively breastfed (day 4). These data suggest that excessive neonatal weight loss among breastfed infants of drug-misusing mothers does not necessarily reflect poorly established lactation and may help to guide management of breast feeding in this population.

Breastfeeding Considerations for Mothers of Infants with Neonatal Abstinence Syndrome

“…Another potential barrier to breastfeeding is the common misconception that the poor weight gain experienced by infants with NAS is misinterpreted as poorly established lactation . There are several reasons for postnatal weight decline in infants with NAS.…”

“…These reasons combined can lead to a net loss of weight early in the life of an infant with NAS. For this reason, early excessive weight loss or failure to regain birth weight in the first week or two of life cannot be taken as a sign of failure to establish lactation as described . In considering the effects of NAS on weight gain in early life, a greater tolerance of weight loss may be appropriate in these infants before supplementing breastfeeding with formula.…”

“…There is a role for the clinician to identify special circumstances related to breastfeeding an infant with or at risk for NAS. An increased tolerance for weight loss or delayed weight gain may aid in establishing successful breastfeeding down the road . Counseling mothers on the danger of potential withdrawal precipitated by abrupt cessation of breastfeeding is another specific role for clinicians .…”

“…Another potential barrier to breastfeeding is the common misconception that the poor weight gain experienced by infants with NAS is misinterpreted as poorly established lactation. 34 There are several reasons for postnatal weight decline in infants with NAS. The weight loss can be attributed to poor, uncoordinated feeding, rapid gut transit, and increased caloric expenditure secondary to jitteriness, tachypnea, and poor sleep patterns.…”

Care of the Infant With Neonatal Abstinence Syndrome

“…9 Dryden and colleagues 9 reported that 437 infants who breast-fed for at least 72 hours significantly reduced the odds of receiving treatment of NAS (odds ra-tio, 0.55; 95% confidence interval, 0.34-0.88; P = .013). 59,60 Unfortunately, not all women who deliver infants with NAS are in a treatment program. 59,60 Even among those mothers who initially chose breast-feeding, only 11% to 15% were still breast-feeding at the time of discharge.…”