Permission to post:

Mom was diagnosed Myasthenia Gravis (MG) in 2003. Medicated with prednisone 10mg daily and Mestinon 30mg twice daily = 60mg daily. Dec 2007 gave birth to first son. Had MG medication throughout pregnancy and throughout breastfeeding him for 1 year. No incidents or side effects.

Feb 2009 - Mom was hospitalized for 17 days with Guillain Barre Syndrome. She has recovered and is 75% back to normal, walks with crutches.

 Sep 2011, gave birth to second baby (3.52 kgs) by Caesarean section with spinal block.

Baby is admitted to NICU for observation due to MG. He had no problems post birth. Baby breastfed.  Mom "passes out" that evening and needs oxygen resuscitation and is given morphine based pain relief by Anaesthetist.

Day 2- baby is circumcised under local, baby very traumatized. (Gynae went ahead with it without consulting the Paed) Day 3 -baby's oxygen levels drop 3 times. All investigations including brain scan & echo of heart come back clear. Mom expresses milk for baby in NICU.

Day 4 -Paed wants to give baby formula as she feels mestinon in breast milk could be causing the desats. Mom continues to express desperately wanting to get baby back onto the breast.

Day 5 -baby on antibiotics and had only one minor desat.  Again all tests clear.

Paed wants Mom to stop breastfeeding as she feels the mestinon could cause further apnoea attacks, but said attacks could also have been caused by :

Post operative drugs given to the mother

Local anaesthetic and trauma post circumcision.

Mother's questions are:

If it is mestinon causing problems why did oxygen desats only started 24 hrs after delivery? Why was her first baby fine breastfeeding while she was on the mestinon?

Is there another way to rule out mestinon as cause of oxygen desats?  Baby has had no further incidents. 

She has been told that if I continues to breastfeed the Mestinon could cause apnoea attacks and he could suffer brain damage. 

Is mestinon absorbed into the infant's plasma?

I have checked the drug in Thomas Hales' book- if anyone has additional info- would be much appreciated.

Thanks so much,

Penny Reimers

IBCLC

 



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