title: Central nervous system depression of neonates breastfed by mothers receiving oxycodone for postpartum analgesia.
abstract: OBJECTIVE
  To quantify the incidence of central nervous system (CNS) depression in neonates breastfed by mothers medicated with oxycodone as compared with neonates whose breastfeeding mothers used codeine or acetaminophen only.
  
  
  METHODS
  We retrospectively compared 3 cohorts in 533 breastfeeding mother-infant pairs exposed to oxycodone (n = 139), codeine (n = 210), or acetaminophen only (n = 184). Standardized questionnaires were administered to mothers during the postpartum period to identify maternal and neonatal health outcomes temporally related to analgesia exposure.
  
  
  RESULTS
  Maternal exposure to oxycodone during breastfeeding was associated with a 20.1% rate of infant CNS depression (28/139) compared with 0.5% in the acetaminophen group (1/184; P < .0001; OR, 46.16; 95% CI, 6.2-344.2) and 16.7% in the codeine group (35/210; P > .05; OR, 0.79; 95% CI, 0.46-1.38). Mothers of neonates with symptoms in the oxycodone and codeine cohorts took significantly higher doses of medication compared with mothers of infants with no symptoms in the same cohorts (P = .0005 oxycodone; median, 0.4 mg/kg/day; range, 0.03-4.06 mg/kg/day versus median, 0.15 mg/kg/day; range, 0.02-2.25 mg/kg/day; codeine P < .001; median, 1.4 mg/kg/day; range, 0.7-10.5 mg/kg/day versus 0.9 mg/kg/day; range, 0.18-5.8 mg/kg/day). Mothers were significantly more likely to experience sedative adverse effects from oxycodone as compared with codeine (P < .0001; OR, 17.62; 95% CI, 9.95-31.21).
  
  
  CONCLUSIONS
  Oxycodone is not a safer alternative to codeine in breastfed infants.
authors: Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.
authors: Jessica
authors: J
authors: Lam
authors: Lauren
authors: L
authors: Kelly
authors: Catherine
authors: C
authors: Ciszkowski
authors: Marieke L A
authors: ML
authors: Landsmeer
authors: Marieke
authors: M
authors: Nauta
authors: Bruce C
authors: BC
authors: Carleton
authors: Michael R
authors: MR
authors: Hayden
authors: Parvaz
authors: P
authors: Madadi
authors: Gideon
authors: G
authors: Koren
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D000328:Adult; D000698:Analgesia; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D001942:Breast Feeding; D002490:Central Nervous System / Q000187:drug effects*; D003061:Codeine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D053609:Lethargy / Q000139:chemically induced* / Q000453:epidemiology; D010098:Oxycodone / Q000009:adverse effects*; D049590:Postpartum Period; D012189:Retrospective Studies
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D010098:Oxycodone; D003061:Codeine