I did this last month for our PNT Committee. It may help some.
Perinatal Meperidine & Breastfeeding
SUMMARY:
Meperidine is a potent opiate analgesic that is rapidly and completely
metabolized by the adult and neonatal liver to an active form, normeperidine.
There is rapid equilibrium of meperidine in maternal plasma and fetus (~6
min).
Small but significant amounts of meperidine are also secreted into
breastmilk.
Half-lives of meperidine (~13 hrs) and normeperidine (~63 hrs) in neonates
are long and could concentrate in the plasma of a neonate.
Infants of mothers treated with meperidine demonstrate neurobehavioral
depression, including poor sucking, for days after exposure, thereby compromising
bonding and breastfeeding.
[In contrast, morphine is a good subarachnoid opiod giving long analgesia
with low dose. Suggest we shouldn’t use morphine antepartum (IV, IM or epidural)
because of neonatal depression in utero & at birth and maternal
nausea/vomiting and rashes. Postpartum: ideal analgesic for breastfeeding mothers due to
high first-pass uptake in liver.]
ANNOTATED LITERATURE REVIEW (1990-2004):
(1) Hale TW. Medications and Mothers’ Milk, 11th Ed, 2004, Pharmasoft
Publishing LP, Amarillo, TX
Overview of meperidine and breastfeeding with references, drug levels. Copy
attached.
(2) Yost NP, Bloom SL, Sibley MK, Lo JY, McIntire DD, Leveno KJ. A
hospital-sponsored quality improvement study of pain management after cesarean
delivery. Am J Ob Gynecol 2004; 190:1341-6
Controlled trial of IM and PCA morphine sulfate and meperidine. Pain reflief
was superior with morphine regimens and was positively associated with
breastfeeding and infant rooming in.
(3) Ransjo-Arvidson AB, Mathiesen AS, Lilja G et al. Maternal Analgesia
During Labor Disturbs Newborn Behavior: Effects on Breastfeeding, Temperature,
and Crying. Birth, March 2001; 28(1):5-12
Video recordings of 28 newborns placed skin to skin post birth. Observers
blinded as to infant exposure to no analgesia vs. mepivacaine via pudendal block
vs. pethidine or more than 1 type of analgesia during labor. Several types
of analgesia may interfere with the newborn’s spontaneous breast-seeking and
breastfeeding behaviors and increase the newborn’s temperature and crying.
(4) Wittels B, Glosten B, Faure EA et al. Postcesarean analgesia with both
epidural morphine and intravenous patient-controlled analgesia:
neurobehavioral outcomes among nursing neonates. Anesth Analg 1997 Sep; 85(3):600-6
Among nursing parturients after cesarean delivery, IV PCA with meperidine is
associated with more neonatal neurobehavioral depression than PCA with
morphine. Even with small doses, meperidine was associated with significantly poorer
neonatal alertness and orientation than morphine.
(5) Nissen E, Widstrom AM, Lilja G et al. Effects of routinely given
pethidine during labor on infants’ developing breastfeeding behavior. Effects of
dose-delivery time interval and various concentrations of pethidine/norpethidine
in cord plasma. Acta Paediatr 1997 Feb; 86(2):201-8
Standard dose of 100 mg pethidine given IM to 13 primips between 1.1-5.3 hrs
(short DDI) and 8.1-9.9 hrs (long DDI) prior to delivery. Infants in short
DDI group had delayed or no suck in 45 min observation period.
(6) Nissen E, Lilja G, Matthiesen AS et al. Effects of maternal pethidine
on infants’ developing breast feeding behavior. Acta Paediatr 1995 Feb;
84(2):140-5
Blinded observational study of 44 infants placed skin-to-skin after delivery.
Those infants exposed to pethidine (18/44 had delayed and depressed sucking
and rooting behavior.
(7) Rajan L. The impact of obstetric procedures and analgesia/anaesthesia
during labor and delivery on breast feeding. Midwifery 1994; 10:87-103
Secondary analysis of data from UK study of pain relief in labor revealed
women who had pethidine late in labor needed extra help with breastfeeding. Only
38% of women given pethidine in labor were breastfeeding at 6 wks
post-delivery, compared to 45% who did not receive the drug.
(8) Righard L, Alade MO. Effect of delivery room routines on success of
first breast-feed. Lancet 1990 Nov 3; 336(8723):1105-7
40/72 infants received pethidine during labor: the infants were sedated and
most (25/40) did not suck at all.
Nancy E. Wight MD, IBCLC, FABM, FAAP
Neonatology
July 14, 2005
Nancy
Nancy E. Wight MD, IBCLC, FABM, FAAP
Neonatologist, Sharp Mary Birch Hospital for Women and Children's Hospital
Medical Director, Sharp HealthCare Lactation Services
San Diego, CA
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