For those of you who work in NICUs, what source do you consider the “ultimate authority“ on using medications with mothers milk with preterm babies?

We use Hale’s text, and if things get too complicated we call Infant Risk Center.

It seems lately Infant Risk is getting more and more conservative vs other sources, and our neonatologists are starting to question why so much milk is being withheld.

Or it could also possibly be moms are just so much sicker lately, and on a lot more medications than they were….. it’s probably a combination of all three.

A recent example: Our maternal fetal medicine team is looking at using enalapril in their algorithm for hypertension.  If you look at LactMed it looks like a perfectly safe medication, but per Hale and Infant Risk Center, there are concerns of renal toxicity with underdeveloped nephrons.  They recommend not using milk between 22 to 32 weeks.  At 33 to 34 weeks they recommend calling Infant Risk and discussing other maternal medication that could possibly be nephrotoxic, to see if it is safe at this point to dilute with donor milk.  They clear it to be used above 35 weeks.

Thank you for any insight you may have!  

Christina Zimpfer RNC, IBCLC
Lactation Consultant
NICU-IMC Unit Council Member
Neonatal Intensive Care
M Health Fairview | University of Minnesota Masonic Children’s Hospital




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