title: A Case of Toxic Breast-feeding?
abstract: Opiates are frequently prescribed postpartum for pain relief after cesarean delivery, episiotomies, and headaches. It is estimated that greater than 30% of breast-feeding mothers in the United States are prescribed opiates for pain relief associated with childbirth. Many opiates are readily transferred to human milk, although life-threatening events are rare. We report a 6-day-old breast-feeding infant whose mother was taking hydromorphone for pain relief from a cesarean delivery and whose clinical course was suggestive of opiate toxicity. This case emphasizes the importance of thorough medication history taking in postpartum breast-feeding mothers whose infants may present with symptoms of opiate toxicity. Semisynthetic opiates are frequently not detected on emergency department urine toxicology screens. The pertinent literature is reviewed.
authors.affiliation: From the Division of Pediatric Emergency Medicine, Children's Hospital of Wisconsin.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Schultz
authors.forename: Mark
authors.initials: M
authors.lastname: Kostic
authors.affiliation: Division of Pediatric Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Sigmund
authors.initials: S
authors.lastname: Kharasch
mesh_terms: D000701:Analgesics, Opioid / Q000506:poisoning*; D001942:Breast Feeding / Q000009:adverse effects*; D006801:Humans; D004091:Hydromorphone / Q000506:poisoning*; D007231:Infant, Newborn; D008895:Milk, Human; D009035:Mothers; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000188:drug therapy; D049590:Postpartum Period
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D004091:Hydromorphone