Postnatal weight loss in substitute methadone ...

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Jul 23, 2010 - Carol Dryden, 1 David Young, 2 Nicole Campbell ,1 Helen Mactier 1. 1Neonatal Unit, Princess Royal. Maternity, Glasgow, Scotland,. UK.
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Postnatal weight loss in substitute methadoneexposed infants: implications for the management of breast feeding Carol Dryden,1 David Young,2 Nicole Campbell,1 Helen Mactier1 1Neonatal

Unit, Princess Royal Maternity, Glasgow, Scotland, UK 2Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK Correspondence to Helen Mactier, Neonatal Unit, Princess Royal Maternity, 16 Alexandra Parade, Glasgow G31 2ER, Scotland, UK; [email protected]. Accepted 20 May 2010 Published Online First 23 July 2010

ABSTRACT It is widely accepted that maternal drug-exposed infants demonstrate excessive early weight loss, but this has not previously been quantified. Among 354 term, substitute methadone-exposed infants, median maximal weight losses were 10.2% and 8.5% for breast- and formula-fed infants, respectively (p=0.003). Weight loss was less in small for gestational age compared to appropriately grown infants (p12%, and in other infants at the discretion of the medical staff, most commonly in association with plasma calcium and magnesium prior to commencing pharmacological treatment for NAS. Breast feeding was defi ned as receipt of maternal breast milk for ≥72 h. Exclusively breastfed infants never received infant formula. Data were anonymised prior to analysis. The local research ethics committee approved this study.

A total of 354 singleton term infants were delivered to 354 substitute methadone-prescribed drug-misusing women over the study period. Data were complete for 98.0% of infants and 98.3% of mothers. Demographics are summarised in table 1. Further demographic details and factors related to the development of NAS have already been described. 2 Infants were nursed by their mother’s bedside unless a specific indication for admission to the NNU was present. Pharmacological treatment for NAS was commenced according to local protocol which included a modified version of the Lipsitz scoring tool. 3 Breast feeding was initiated in 105 mother–infant pairs (29.7%) and a further four infants received their own mother’s expressed breast milk. One mother was HIV positive and advised against breast feeding, but otherwise breast feeding was actively encouraged. In total, 72 infants (20.3%) received breast milk for at least the fi rst 72 h of life, with 50 of these also receiving supplementary feeds of infant formula. At discharge 34% of supplemented breastfed infants were still breast feeding compared to 100% of those 22 infants exclusively breast fed for the fi rst 72 h (p