I did this last month for our PNT Committee. It may help some. Perinatal Meperidine & Breastfeeding SUMMARY: Meperidine is a potent opiate analgesic that is rapidly and completely metabolized by the adult and neonatal liver to an active form, normeperidine. There is rapid equilibrium of meperidine in maternal plasma and fetus (~6 min). Small but significant amounts of meperidine are also secreted into breastmilk. Half-lives of meperidine (~13 hrs) and normeperidine (~63 hrs) in neonates are long and could concentrate in the plasma of a neonate. Infants of mothers treated with meperidine demonstrate neurobehavioral depression, including poor sucking, for days after exposure, thereby compromising bonding and breastfeeding. [In contrast, morphine is a good subarachnoid opiod giving long analgesia with low dose. Suggest we shouldn’t use morphine antepartum (IV, IM or epidural) because of neonatal depression in utero & at birth and maternal nausea/vomiting and rashes. Postpartum: ideal analgesic for breastfeeding mothers due to high first-pass uptake in liver.] ANNOTATED LITERATURE REVIEW (1990-2004): (1) Hale TW. Medications and Mothers’ Milk, 11th Ed, 2004, Pharmasoft Publishing LP, Amarillo, TX Overview of meperidine and breastfeeding with references, drug levels. Copy attached. (2) Yost NP, Bloom SL, Sibley MK, Lo JY, McIntire DD, Leveno KJ. A hospital-sponsored quality improvement study of pain management after cesarean delivery. Am J Ob Gynecol 2004; 190:1341-6 Controlled trial of IM and PCA morphine sulfate and meperidine. Pain reflief was superior with morphine regimens and was positively associated with breastfeeding and infant rooming in. (3) Ransjo-Arvidson AB, Mathiesen AS, Lilja G et al. Maternal Analgesia During Labor Disturbs Newborn Behavior: Effects on Breastfeeding, Temperature, and Crying. Birth, March 2001; 28(1):5-12 Video recordings of 28 newborns placed skin to skin post birth. Observers blinded as to infant exposure to no analgesia vs. mepivacaine via pudendal block vs. pethidine or more than 1 type of analgesia during labor. Several types of analgesia may interfere with the newborn’s spontaneous breast-seeking and breastfeeding behaviors and increase the newborn’s temperature and crying. (4) Wittels B, Glosten B, Faure EA et al. Postcesarean analgesia with both epidural morphine and intravenous patient-controlled analgesia: neurobehavioral outcomes among nursing neonates. Anesth Analg 1997 Sep; 85(3):600-6 Among nursing parturients after cesarean delivery, IV PCA with meperidine is associated with more neonatal neurobehavioral depression than PCA with morphine. Even with small doses, meperidine was associated with significantly poorer neonatal alertness and orientation than morphine. (5) Nissen E, Widstrom AM, Lilja G et al. Effects of routinely given pethidine during labor on infants’ developing breastfeeding behavior. Effects of dose-delivery time interval and various concentrations of pethidine/norpethidine in cord plasma. Acta Paediatr 1997 Feb; 86(2):201-8 Standard dose of 100 mg pethidine given IM to 13 primips between 1.1-5.3 hrs (short DDI) and 8.1-9.9 hrs (long DDI) prior to delivery. Infants in short DDI group had delayed or no suck in 45 min observation period. (6) Nissen E, Lilja G, Matthiesen AS et al. Effects of maternal pethidine on infants’ developing breast feeding behavior. Acta Paediatr 1995 Feb; 84(2):140-5 Blinded observational study of 44 infants placed skin-to-skin after delivery. Those infants exposed to pethidine (18/44 had delayed and depressed sucking and rooting behavior. (7) Rajan L. The impact of obstetric procedures and analgesia/anaesthesia during labor and delivery on breast feeding. Midwifery 1994; 10:87-103 Secondary analysis of data from UK study of pain relief in labor revealed women who had pethidine late in labor needed extra help with breastfeeding. Only 38% of women given pethidine in labor were breastfeeding at 6 wks post-delivery, compared to 45% who did not receive the drug. (8) Righard L, Alade MO. Effect of delivery room routines on success of first breast-feed. Lancet 1990 Nov 3; 336(8723):1105-7 40/72 infants received pethidine during labor: the infants were sedated and most (25/40) did not suck at all. Nancy E. Wight MD, IBCLC, FABM, FAAP Neonatology July 14, 2005 Nancy Nancy E. Wight MD, IBCLC, FABM, FAAP Neonatologist, Sharp Mary Birch Hospital for Women and Children's Hospital Medical Director, Sharp HealthCare Lactation Services San Diego, CA [log in to unmask] *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html