If this mother will be taking care of her baby, she should be encouraged to
breastfeed.  I realize this baby will get possibly small amounts of drug,
but he's getting it now, isn't he?  I realize that the mother is
metabolizing the drug for him, but does that mean he is not liable to get
agranulocytosis because he is exposed in utero?  Surely, watching the baby
(since we are watching him and his mother anyhow), possibly doing milk
levels in the mother (for research, don't forget we want to know) would
allow us gingerly to use such a medication and encourage the mother to
breastfeed.  The team is willing to risk having this baby in this mother's
care and it sounds like a significant risk.  But not willing to risk her
breastfeeding?

Jack Newman, MD, FRCPC