Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. 869 (doi:10.1542/peds.2008-0217)
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LETTER TO THE EDITOR

Methadone Maintenance and Breastfeeding in the Neonatal Period

Anthony J. W. Liu
Ralph Nanan
Department of Pediatrics
Nepean Clinical School
University of Sydney
Penrith, New South Wales, 2751
Australia

To the Editor.—

We would like to commend Jansson et al for their study titled "Methadone Maintenance and Breastfeeding in the Neonatal Period."1 Their data show that concentrations of methadone in breast milk are low, remain stable over time, and do not influence methadone serum concentrations in the infant. Thus, methadone in breast milk is unlikely to have any significant pharmacological or clinical effects. Despite this, a positive effect of breastfeeding has been suggested by the authors and is supported by a report by Abdel-Latif et al,2 which documented that breastfeeding has a significant positive impact on the neonate (eg, later onset of withdrawal, decreased length of treatment, and lower maximum morphine dose required). It has been recognized that supportive care (ie, swaddling and frequent small feeding) is helpful in the management of neonatal withdrawal and this would be more consistent with the actual act of breastfeeding than with formula feeding.3 We wonder if the effects of breastfeeding are therefore more related to the mother-child bonding and swaddling experience than to the components of breast milk. In this context, it would be of interest to investigate or analyze whether the positive effects of breast milk are also seen with expressed breast milk versus formula given by bottle. Independent of the mechanisms involved, recommendations for breastfeeding in methadone-maintained women seem warranted.

REFERENCES

  1. Jansson LM, Choo R, Velez ML, et al. Methadone maintenance and breastfeeding in the neonatal period. Pediatrics. 2008;121 (1):106 –114[Abstract/Free Full Text]
  2. Abdel-Latif ME, Pinner J, Clews S, Cooke F, Lui K, Oei J. Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent mothers. Pediatrics. 2006;117 (6). Available at: www.pediatrics.org/cgi/content/full/117/6/e1163
  3. Anonymous. Neonatal drug withdrawal. American Academy of Pediatrics Committee on Drugs [published correction appears in Pediatrics. 1998;102(3 pt 1):660]. Pediatrics. 1998;101 (6):1079 –1088[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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[Abstract] [Full Text] [PDF]

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