A newborn boy is being evaluated in the nursery. The patient was born to a 24-year-old primigravida following a pregnancy complicated by polysubstance use, including opioids, benzodiazepines, and alcohol. The mother is now adherent to a methadone addiction management program and is taking sertraline for depression. The patient was born via cesarean delivery and was vigorous, with a birth weight of 3.8 kg (8 lb 8 oz). Newborn examination appears consistent with a near-term gestation and is otherwise unremarkable. Maternal and newborn urine drug screens are positive for opioids only. While the patient is being treated in the nursery, the mother asks if she will be able to breastfeed her newborn. Which of the following is an absolute contraindication to breastfeeding in this patient?

Question

A newborn boy is being evaluated in the nursery.  The patient was born to a 24-year-old primigravida following a pregnancy complicated by polysubstance use, including opioids, benzodiazepines, and alcohol.  The mother is now adherent to a methadone addiction management program and is taking sertraline for depression.  The patient was born via cesarean delivery and was vigorous, with a birth weight of 3.8 kg (8 lb 8 oz).  Newborn examination appears consistent with a near-term gestation and is otherwise unremarkable.  Maternal and newborn urine drug screens are positive for opioids only.  While the patient is being treated in the nursery, the mother asks if she will be able to breastfeed her newborn.  Which of the following is an absolute contraindication to breastfeeding in this patient?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d675_9640_bc81_65fb0d67c43e_MD0003_00 Breast milk is the ideal form of nutrition for the first 6 months of life, and exclusive breastfeeding is strongly recommended. Breastfeeding has advantages both for the mother (eg, decreased risk of breast and ovarian cancers) and newborn (eg, reduced illness). However, breastfeeding is unsafe in certain circumstances. Common contraindications include: Galactosemia in the newborn Maternal HIV infection in developed nations where formula is available Herpetic breast lesions Most chemotherapy and radiation therapy Active tuberculosis until no longer contagious (ie, 2 weeks of antituberculin therapy) Active substance use disorder without enrollment in a methadone or buprenorphine treatment program Although this mother has a history of polysubstance use disorder, breastfeeding is not contraindicated because she is adherent to methadone maintenance therapy with a negative drug screen for other (ie, nonopioid) substances (Choice D). Concentrations of methadone in breastmilk are low, and breastfeeding can be encouraged regardless of the prescribed dose (Choice B). In addition, newborns of mothers taking methadone during pregnancy are at increased risk for neonatal abstinence syndrome (ie, withdrawal from in utero exposure to opioids). Breastfeeding decreases the duration and severity of symptoms in these newborns. (Choice A) Maternal blood alcohol level (eg, legal limit of 0.08) closely matches the level of alcohol in breastmilk, which translates to a generally low percentage (eg, 0.08%) of alcohol ingested by the breastfeeding newborn. Therefore, casual, moderate alcohol use is considered safe and not a contraindication to breastfeeding. (Choice E) Levels of sertraline are low in breast milk. This medication is a safe, recommended antidepressant for breastfeeding mothers. Educational objective: Exclusive breastfeeding for the first 6 months of life is recommended unless contraindications are present. Although active substance use disorder is not compatible with breastfeeding, mothers on a methadone treatment program can breastfeed. References: ABM clinical protocol #21: guidelines for breastfeeding and substance use or substance use disorder, revised 2015. (http://www.ncbi.nlm.nih.gov/pubmed/25836677) Breastfeeding and the use of human milk. (http://www.ncbi.nlm.nih.gov/pubmed/22371471)

A Newborn Boy Is Being Evaluated in the Nursery