Help needed:

21 y.o. insulin dependent diabetic since age 8 delivered 35 week preterm
female on
5-1-97 who weighed 4 pounds one ounce. .  Mom also is legally blind and known
to have decreased renal function.  No known dx of renal disease.  Mom
currently taking Humulin N and Humulin R insulins and does finger stick blood
sugars four times per day.  Blood sugar levels during pregnancy were in the
110 range and there were no ketones in the urine.  Current finger stick blood
sugars below 100.  Had pregnancy induced hypertension and delivered baby
early.  Has been on magnesium sulfate and today (day 4 of baby's life) was
given to OK to pump for her baby.

  Question:  Mom now on capoten (captoprin) and aldomet (methyldopa) which
are both approved as safe for breastfeeding but with mom's reduced renal
threshold neonatologist wants an estimate if possible as to what amount of
these meds will get through milk into the baby.

 Baby also having significant reflux and apnea and bradycardia on Neocare
formula.

 MMM also states that the side effects of these drugs are --capoten:
hypotension, bradycardia, and among others decreased urine output.  Aldomet's
significant side effect also is hypotension.  Therefore, the neonatologist's
question.

  Mom's lab values as of 5-5-97 are Hemoglobin 8.0 (low); hematocrit 22.9
(low); creatinine 2.0 (high) Blood Urea nitrogen ( 23 (high) ; calcium 97.7
(low) and phosphorus 3.5 ( normal).  Mom also still having 4 plus edema and
sees her "kidney" doctor later this week.

Second question:  If we ok use of pump or breastfeeding, will we be adding to
mom's  kidney load and further stressing this mom?

 No md has discouraged breastfeeding and no md has encouraged it either.  She
states one of our neos suggested that she consider breastfeeding for at least
2 weeks if possible.  She has planned to exclusively breastfeed for as long
as possible so this was not a problem for her .  This mom asked for more
information from breastfeeding friendly MD's pro or con so that she can make
an intelligent decision.

Thanks for all input.

Any thoughts or suggestions would really be appreciated by this mom.  She
really wants to breastfeed but also is willing to pump until baby is older if
necessary. If she must abandon breastfeeding for her own health, she will
"deal" with that , too.

P.S.  While speaking with me in nursery after visiting hours tonight,  she
abandoned her breast pump (too hard) and was able to manually express a
little over 3 1/2 ounces for her baby in less than ten minutes.  This milk is
now in Special Care freezer awaiting answers to doctor's question.  YEA MOM!!
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Arnetta Dailey RN IBCLC
The Woodlands Texas
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