Today's Medscape had an interesting piece of news on safety labeling  
revisions for nalbuphine (Nubain) used during labor and delivery. The new  labeling 
will state that nalbuphine injections are associated with a risk for  serious 
fetal and neonatal adverse events. They list these as fetal bradycardia,  
respiratory depression at birth, apnea, cyanosis, and hypotonia. Some events  have 
been reported as life threatening. They go on to state that severe  prolonged 
bradycardia has occurred that has resulted in permanent neurologic  damage and 
that infants should be monitored following birth for respiratory  depression, 
apnea, bradycardia, and arrhythmias. 
_www.medscape.com/viewarticle/518110_print_ (http://www.medscape.com/viewarticle/518110_print) 
 
The article does not say anything about the potential combination of  
nalbuphine followed by an epidural with fentanyl and the effect this would have  on 
an infant's ability to breastfeed. It's no wonder we have so many early  
breastfeeding problems. I wonder how many mothers will be informed of this  drug's 
potential to harm their infant. Given the number of babies discharged  from the 
hospital who have never really swallowed milk at the breast, this piece  of 
information perhaps gives us another clue as to why we see such poor  
breastfeeding outcomes in so many mothers and babies.
 
Marsha Walker, RN, IBCLC
Weston, MA

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