Kathy, and others I just wanted to share my efforts at changing policy and
educating staff that paid off. With the help of Kathy I armed myself with
information on breastfeeding and contrast media. I then wrote the letter below
to the head of the radiology dept. Then following my note is his response.
I hope this inspires others to do the research on a topic you feel needs to
be changed and make then act on your efforts.
____________________________________
From: Perry, Ann M.
Sent: Tue 8/9/2005 12:39 PM
Subject: Iodinated contrast media in lactating patients
Dear Dr. Dobrow,
I am the lactation consult for the NSCM and work out of the maternity. This
weekend a postpartum patient needed a CT scan and Ultravista was the media
used. She was given a paper regarding IV contrast adm in pts who are
breastfeeding that states : "because many contrast agents are excreted unchanged in
the human milk, it is recommended that nursing mothers be advised to pump and
discard their breast milk for 24 hours following the injection of IV contrast
administration. Questions about substitute bottle feedings should be
referred to the pediatrician. The technologist should consult with the radiologist
about the possibility of alternative testing prior to injecting contrast
material."
I have been doing some investigations into guidelines for contrast mediums
and the sources I have found state that breastfeeding is not contraindicated
with these agents. Here is what I found.
From the ACR Bulletin, Oct 2001
They say in this bulletin regarding Iodinated X-Ray Contrast Media (Ionic
and Nonionic): Because of its low lipid solubility, less than 1% of the
administered material dose of iodinated contrast medium is excreted into the breast
milk in the first 24 hours. Because less than 1% of the contrast medium
ingested by the infant is absorbed from its gastrointestinal tract, the expected
dose absorbed by the infant from the breast milk is less than 0.01% of the
intravscular dose given to the mother. This amount of contrast medium
represents less than 1% of the recommended dose for an infant undergoing an imaging
study, which is 2 mL/kg.
Recommendation: Mothers who are breastfeeding should be given the
opportunity to make an informed decision as to whether to continue breastfeeding or
temporarily abstain.
Because of the very small percentage of iodinated contrast medium that is
excreted into the breast milk and absorbed by the infant's gut, we believe that
the available data suggest that it is safe for the mother and infant to
continue breastfeeding after receiving such an agent.
In another search I found the ESUR Guidelines on Contrast Media and this
what they stated:
Iodinated agents: Breastfeeding may be continued normally when iodinated
agents are given to the mother.
Gadolinium agents: Breastfeeding may be continued normally when gadolinium
agents are given to mothers.
Source: JAW Webb, HS Thomsen, SK Morcos and members of the Contrast Media
Safety Committee of the European Society of Urogenital Radiology (ESUR). The
use of iodinated and gadolinium contrast media during pregnancy and lactation.
Eur Radiol 2005;15
I would very much like to discuss with you the recommendations you are
making to lactating patients when they have these tests.
Thank you for your time and I look forward to hearing from you.
Ann Perry, RN IBCLC
-----Original Message-----
From: Dobrow, Richard A.,M.D.
Sent: Tuesday, August 09, 2005 1:19 PM
Subject: RE: Iodinated contrast media in lactating patients
Great work Ann !!! You obviously have found out more recent information then
we had included in our protocol. I will forward this to Dr. Tim Hough,
Director of CT and Dr. Howard Lowy, Director of MRI. I hope they will agree and
institute the recommendations you found in your recent literature search. Once
again, thank you very much...RD
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