Drug distribution in human milk

Kenneth F. Ilett, Judith H. Kristensen

Aust Prescr 1997;20:35-40

Summary

Assessing the safety of breast feeding during maternal drug therapy is an individualised risk:benefit analysis. An infant’s exposure depends on drug transfer into milk, daily milk intake and the bioavailability of the drug in the infant. Exposure and the potential for adverse effects is greatest in premature neonates and decreases over the first few months of life as the infant’s clearance mechanisms mature. Risk should be assessed in the light of the inherent toxicity of the drug and any published data on milk transfer and infant exposure. When maternal drug therapy is necessary, the breast-fed infant should be regularly assessed for adverse effects such as sedation, failure to thrive and achievement of developmental milestones.
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Vasospasm of the nipple–a manifestation of Raynaud’s phenomenon: case reports

Laureen Lawlor-Smith, Carolyn Lawlor-Smith

BMJ 1997;314:644

Raynaud’s phenomenon was first described by Maurice Raynaud in 1862. It is defined as intermittent ischaemia affecting the acral parts of the body, most commonly the fingers or toes. It is much more prevalent in women, with a female to male ratio of 9:1. It is common in healthy women of childbearing age, affecting up to 22% of healthy women in the 21-50 year age group. Nipple pain is the most common symptom in breastfeeding women and is the second most common reason given for abandoning breastfeeding, exceeded only by perceived low milk supply. We report on five women with Raynaud’s phenomenon affecting their nipples.
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Pacifier Use and Short Breastfeeding Duration: Cause, Consequence, or Coincidence?

Cesar Gomes Victora, Dominique Pareja Behague, Fernando Celso Barros, Maria Teresa Anselmo Olinto, and Elizabeth Weiderpass

PEDIATRICS Vol. 99 No. 3 March 1997, pp. 445-453

Abstract

Objectives. Pacifiers are related to a shorter duration of breastfeeding. However, it is unclear whether this association is causal, because confounding, reverse causality, and self-selection of mothers may play a role. These issues were investigated through a combination of epidemiologic and ethnographic research in southern Brazil.

Methodology. A population-based cohort of 650 mothers and infants were visited shortly after delivery and at 1, 3, and 6 months. The rate of complete follow-up was 96.8%. A subsample of 80 mothers and infants was selected for the ethnographic study, which included in-depth interviews and participant observations in the age range of 2 to 6 months with a mean of 4.5 visits.
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Blood and milk prolactin and the rate of milk synthesis in women

DB Cox, RA Owens, and PE Hartmann

Exp Physiol 1996;81;1007-1020

In women, the concentration of prolactin in the plasma increases in response to nipple stimulation. This response has led to the assumption that prolactin influences the rate of milk synthesis. To investigate this hypothesis we have measured 24 h milk production, the short-term (between breastfeeds) rates of milk synthesis and the concentration of prolactin in the blood and breastmilk, from 1 to 6 months of lactation in eleven women.

Over the long term, the 24 h milk production remained constant (means +/- S.E.M.): 708 +/- 54.7 g/24 h (n = 11) and 742 +/- 79.4 g/24 h (n = 9) at 1 and 6 months, respectively.
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Frequency and degree of milk removal and the short-term control of human milk synthesis

SE Daly, JC Kent, RA Owens and PE Hartmann

Exp Physiol 1996;81;861-875

SUMMARY

The effect of the temporal spacing and degree of milk removal by either expression or breastfeed on short-term (hour to hour) rates of milk synthesis was investigated. For four expressing mothers(three of whom had given birth prematurely), the relationship between milk produced at an expression and the time since the last expression showed that proportionally less milk is produced after intervals of 6-18 h than after intervals of less than 6 h (P < 0,0002).

For five breastfeeding and four expressing mothers (three of whom had gixren birth prematurely), rates of milk synthesis (ranging from 0 to 56 mi/h) were linear between breastfeeds and expressions (intervals ranging from < 1 h to 6 h).
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Maternal Medication Use During Breastfeeding

Pediatric Pharmacotherapy
Volume 2, Number 4, April 1996

Assessing and Minimizing the Risk

Assessing the risk of maternal medication use in the breastfeeding infant continues to be one of the more difficult tasks faced by health care providers in obstetrics, pediatrics, and family medicine. Despite the dramatic increase in the percentage of women choosing to breastfeed, our knowledge of the safety of most medications remains limited. Research into the quantity of drug transferred into milk is complex and provides only a limited degree of certainty on the safety of medication use. However, this lack of scientific data should not lead to the conclusion that most medications are unsafe.
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Dealing With Tongue-Tie

By Joni Niedert
Kenner LA USA
From: NEW BEGINNINGS, Vol. 13 No. 2, March-April 1996, pp. 41-2

When I discovered I was pregnant for the third time, I didn’t give much thought to breastfeeding. I would just care for the baby the way I had taken care of her two older brothers. I would breastfeed on demand, cuddle, and treat this new member of our family as the special, delicate gift that she certainly would be. I did reread my copy of THE WOMANLY ART OF BREASTFEEDING to refresh my memory about certain things, but after all my experience with Jason and Matthew, I didn’t believe that there was anything I would run into that I wasn’t prepared for.
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Distribution and excretion of sumatriptan in human milk

R. E. WOJNAR-HORTON, L. P. HACKETT, P. YAPP, L. J. DUSCI, M. PAECH, K. F. ILETT
Br J Clin Pharmacol 1996; 41: 217-221

Abstract

  1. The excretion of a 6 mg subcutaneous dose of sumatriptan in breast milk was studied in five lactating volunteer subjects with a mean age of 27.6 years and a mean body weight of 75 kg. Drug concentrations in milk and plasma over the ensuing 8 h were measured by high-performance liquid chromatography.
  2. The mean milk:plasma ratio estimated from the areas under the milk and plasma concentration-time curves (AUC) was 4.9 (95% CI 4.1–5.7), indicating a significant transfer of sumatriptan into the milk compartment.

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Postpartum Breastfeeding Assessments

Verity Livingstone

Journal SOGC February 1996

Abstract

Despite a high initiation rate of breastfeeding in hospital, most mothers stop breastfeeding within a few weeks, “The window of professional unavailability” and lack of breastfeeding management skills among health professionals are partly to blame. This article, the third in a series, reviews the physiology of ongoing lactation, and outlines a protocol for post-partum breastfeeding that can be incorporated into routine postpartum management.

It reviews the early detection of infants at risk for breastfeeding difficulties and insufficient milk intake. It outlines topics for discussion and anticipatory guidance at age appropriate intervals including breastfeeding and sexuality, introduction of solids, and child led weaning.
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Excretion of fluoxetine and its metabolite, norfluoxetine, in human breast milk

A Taddio, S Ito, and G Koren

The Journal of Clinical Pharmacology, 1996; 36:42-47

A study was conducted to measure breast milk concentrations of fluoxetine and its active metabolite, norfluoxetine, excreted in breast milk in a cohort of nursing women using fluoxetine, and to estimate infant dose from nursing.

The study included 10 women nursing 11 infants (median age, 185 days). The mean fluoxetine dose was 0.39 mg/kg/day. Each patient manually collected 3 to 6 milk samples throughout a dosing interval. Concentrations of fluoxetine and norfluoxetine in milk were measured by gas-liquid chromatography. Mothers reported whether they observed adverse effects in their infants.
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