A mother has been prescribed a six-day course of prednisone, 60 mg, to be
taken once a day, for reflux.   The mother is a large woman; the baby is a
healthy 3-month-old, about 12 1/2 pounds.

All of our information indicated that if she took the dose last thing at
night and allowed at least 4 hours to elapse before the next breastfeeding,
this dose would be compatible with continued breastfeeding.

Her physician disagreed, saying there was an unacceptably high risk of
viral meningitis.

Neither I, nor the hospital's librarian, nor my husband, could find any
mention of this possible link in the literature.  My co-worker informed the
mother's MD, who stated that nevertheless, he advised discontinuing
breastfeeding for a week, and pumping & dumping.

I presented the case to the baby's pediatrician, listing (a) our findings
re:compatibility of bf and the drug, including details as to availability
through BrM; (b) the other MD's concern; (c) my inability to support that
concern after a search in the literature.  I asked him to advise.  He
advised the mother to continue nursing his little patient, saying he could
not support a particular concern for viral meningitis.  I conveyed this
message to the mother, saying her baby's physician believed risk of viral
meningitis to be low (explained the difference between low and
non-existent) and outweighed by the risk of formula feeding.  She will
continue to nurse.

Now, how many of you would inform the mother's MD yourself, and how many
would let the mother take the responsibility?  If you decide to communicate
to the mother's physician, how much of the above would you convey?

Arly Helm                                       [log in to unmask]