Infants lactation

Penicillins should be used cautiously in patients witii renal disease, pregnancy (Pregnancy Category C), lactation (may cause diarrhea or candidiasis in die infant), and in tiiose witii a history of allergies. Any indication of sensitivity is reason for caution. The drug is also used witii caution in patients witii asthma, renal disease, bleeding disorders, and gastrointestinal disease. 

This drug is contraindicated in known cases of hypersensitivity to spectinomycin. In addition, the drug should not be given to infants. If another sexually transmitted disease is present with gonorrhea, additional anti-infectives may be needed to eradicate the infectious processes. Safe use during pregnancy (Category B) or lactation or in children has not been established. 

The bile acid sequestrants are contraindicated in patients with known hypersensitivity to the drugs. Bile acid sequestrants are also contraindicated in those with complete biliary obstruction. These drags are used cautiously in patients with a history of liver or kidney disease Bile acid sequestrants are used cautiously during pregnancy (Pregnancy Category C) and lactation (decreased absorption of vitamins may affect the infant). 

Donovan, S.M., Atkinson, S.A and Lonnerdal, B. 1986 Total nitrogen and non-protein nitrogen balance in preterm infants fed preterm human milk. In Jensen, R.G. and Neville, M.C., eds.. Human Lactation 2. Maternal and environmental factors. New York, Plenum Press 603-610. 

While unnecessary medications clearly should be avoided during pregnancy or lactation, clinicians also should avoid undertreating conditions that can lead to adverse maternal, fetal, or infant outcomes. Additionally, clinicians should avoid unnecessarily discouraging breast-feeding because breast milk provides nutritional and immunologic benefit to the infant. 

During lactation, sucralfate maybe the best choice for treatment of heartburn because it is not absorbed systemically.25 If symptoms are not controlled, the H2 blockers are acceptable alternatives.14,25 Avoid aluminum-containing antacids during lactation owing to reports of aluminum toxicity in otherwise healthy infants.22... 

Advise women requiring treatment for trichomoniasis during lactation to discontinue breast-feeding for 12 to 24 hours after receiving single-dose metronidazole therapy in order to minimize risk to the infant.14 During this time, advise women to pump and discard breast milk in order to avoid engorgement. 

In a review of data on occupational chemicals that may contaminate breast milk (Byczkowski et al. 1994), it is stated that lead may be excreted in milk in amounts lethal to the infant and that the metal may be mobilized from bone stores to milk during the lactation period. Even when the concentration of lead in mother s milk is low, the absorption of metals into the systemic circulation of infants is generally high when they are on a milk diet. To better understand the sensitivity of the nursing infant to chemicals, epidemiological studies, chemical monitoring, and model development and application are needed. 

Settergren, G., Lindblad, B. S. and Persson, B. Cerebral blood flow and exchange of oxygen, glucose, ketone bodies, lactate, pyruvate and amino acids in infants. Acta Paediatr. 

Dewey, K.G., Nommsen, L.A., Heinig, M.J., and Cohen, RJ. (2003). Risk factors for subopti-mal infant breastdeefing behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 112, 607-619. 

Doucet, S., Soussignan, R., Sagot, P., and Schaal, B. (2007c). The areolar glands in postpartuiient women and their links with breastfeeding, lactation onset and early infant growth. Unpublished manuscript. 

A model describing transfer of -hexane via lactation from a mother to a nursing infant is also available (Fisher et al. 1997). Human milk/blood partition coefficients for 19 volatile organic chemicals including u-hexane were experimentally determined using samples from volunteers. These parameters were used to estimate the amount of w-hcxanc an infant would ingest from milk if the mother was occupationally exposed to w-hcxanc at the Threshold Limit Value (TLV) throughout a workday. 

There is no experimental evidence available to assess whether the toxicokinetics of -hexane differ between children and adults. Experiments in the rat model comparing kinetic parameters in weanling and mature animals after exposure to -hexane would be useful. These experiments should be designed to determine the concentration-time dependence (area under the curve) for blood levels of the neurotoxic /7-hcxane metabolite 2,5-hexanedione. w-Hcxanc and its metabolites cross the placenta in the rat (Bus et al. 1979) however, no preferential distribution to the fetus was observed. -Hexane has been detected, but not quantified, in human breast milk (Pellizzari et al. 1982), and a milk/blood partition coefficient of 2.10 has been determined experimentally in humans (Fisher et al. 1997). However, no pharmacokinetic experiments are available to confirm that -hexane or its metabolites are actually transferred to breast milk. Based on studies in humans, it appears unlikely that significant amounts of -hexane would be stored in human tissues at likely levels of exposure, so it is unlikely that maternal stores would be released upon pregnancy or lactation. A PBPK model is available for the transfer of M-hcxanc from milk to a nursing infant (Fisher et al. 1997) the model predicted that -hcxane intake by a nursing infant whose mother was exposed to 50 ppm at work would be well below the EPA advisory level for a 10-kg infant. However, this model cannot be validated without data on -hexane content in milk under known exposure conditions. 

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