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Subject:
From:
Arly Helm <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 7 Mar 2006 15:03:40 -0800
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Has anyone seen severe diarrhea in an infant undergoing opiate
detoxification? If so, what successful or unsuccessful treatments were used?

The following info has been related to me secondhand by another health care
professional who seeks help. I have not seen the clients. Meanwhile, here is
the history thus far:

Mother "Jane" was on high levels of meperidine throughout pregnancy for
intractable severe migraine. Baby "John" is 3 wks of age, being treated w/
.1mg/d opium tincture for detox, while mom is receiving fentanyl for detox.
Hale says "The transfer of fentanyl into human milk has been documented but
is low."

Baby is happy and acting normally for his age but stools q 5-10 min and has
concomitant severe red ("scalded") diaper rash, w smooth aspect (no rash or
bumps).

It would of course be possible to decrease foremilk:hindmilk ratio to slow
digestion as a way of manipulating the baby's environment in a helpful way,
irrespective of whether the there is any foremilk:hindmilk imbalance. In
other words, assuming the balance between foremilk and hindmilk is just
right for a healthy baby, and given that this baby is not healthy, it would
be possible to effect a change in motility by [temporarily] artificially
increasing the amount of hindmilk the baby consumes. 

However, there is a high probability that this is not primarily a
breastfeeding problem, and that breastfeeding, which is going well per mom,
should be left strictly alone and a non-feeding solution (topical or
systemic medication) found by the baby's pediatrician. There is a risk that
manipulating breastfeeding would inappropriately focus attention on the
feeding, when it is not the problem, and that making breastfeeding more
difficult, through artificial manipulation, would endanger its long-term
success.

If the breastfeeding is not the problem and will not be featured in the
solution, other than to keep it going successfully, then I am out of the
loop at this point. It is up to the pediatrician to find a solution. Solid
foods are of course out of the question, due to the baby's age. I can
speculate that an increase in baby's opiate dose would be constipating, but
as baby is emotionally happy and without distress there is no indication for
an increase in opiates. In regard to anti-motility agents in infancy, such
as loperamide, the CDC says: "The use of antimotility agents (e.g.,
loperamide, lomotil) in children <2 years of age is not recommended. Because
overdoses of these types of drugs can be fatal, they should be used with
extreme caution in children. Side effects of these drugs in adults include
opiate-induced ileus, drowsiness, and nausea. Lomotil has been associated
with fatal overdoses and other severe complications, including coma and
respiratory depression."

My responsibility is limited to ruling out breastfeeding as a causative
agent and supporting continued breastfeeding. I have no idea what solution
the pediatrician will come up with. My guess is that if weight gain and
hydration are good, he will recommend a topical agent to shield the baby's
skin; however, I am concerned that it is difficult for an infant--even a
breastfed infant--to maintain hydration with the stooling schedule
described.

Arly Helm, MS, IBCLC

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