Nursing infants

Mercury has also been implicated in the etiology of acrodynia (pink disease) in children when mercury-containing teething powder was used. The methyl mercury contained in fungicides has been responsible for toxicity in children in Iraq. This toxicity is characterized by phalangeal erythema, muscular weakness, ataxia, hyperirritability, sensory impairment, visual disturbances, involuntary movement, and sometimes unconsciousness. 

NYSTATIN/TRIAMCINOLONE ACETONmE (Mycogen II cream 100,000 units/g nystatin, 0.1% triamcinolone, ointment 100,000 units/g nystatin, 0.1% triamcinolone, Mycolog II cream, 100,000 units/g nystatin, 0.1 % triamcinolone, Mytrex cream 100,000 units/g nystatin, 0.1% triamcinolone, ointment 100,000 units/g nystatin, 0.1% triamcinolone) 

Nystatin (Mycostatin, Nilstat, others) is useful only for candidiasis and is supplied in preparations intended for 

Vaginal tablets containing 100,000 units of the drug are inserted once daily for 2 weeks. Although the tablets are well tolerated, imidazoles or triazoles are more effective agents than nystatin for vaginal candidiasis. 

An oral suspension that contains 100,000 units/ml of nystatin is given fom times a day. Premature and low-birth-weight neonates should receive 1 mL of this preparation, infants 2 mL, and children or adults 4 to 6 mL per dose. Older children and adults should be instructed to swish the drug around the mouth and then swallow. If not otherwise instructed, the patient may expectorate the bitter liquid and fail to treat the infected mucosa in the posterior pharynx or esophagus. Nystatin suspension is usually effective for oral candidiasis of the immunocompetent host. Other than the bitter taste and occasional complaints of nausea, adverse effects are uncommou. A 200,000-unit troche (mycostatin pastilles) is available for the treatment of oral candidiasis, and a 500,000-unit oral tablet is sold for the treatment of nonesophageal membrane G1 candidiasis. 

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Children are expected to be exposed to methyl parathion by the same routes that affect adults. Small children are more likely to come into contact with methyl parathion residues that may be present in soil and dust both outside and inside the home, due to increased hand-to-mouth activity and playing habits. Methyl parathion has been detected in a few samples of breast milk, indicating potential for exposure of nursing infants. However, available data are not adequate for determination of the importance of this route of child exposure. 

Since no studies have been conducted in pregnant women, phentermine should be administered only when clearly indicated. Owing to the potential for severe adverse effects in nursing infants, a decision to stop the drug or discontinue nursing must be made.38... 

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. 

Serum concentrations in the nursing infant are 10% to 50% of the mother s serum concentration, thus breast-feeding is usually discouraged for women taking lithium. 

McLachlan, M.S. Digestive tract absorption of polychlorinated diobenzo-p-dioxins, dibenzofurans, and biphenyls in a nursing infant, Toxicol. Appl. Pharmacol., 123, 68, 1993. 

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. 

The Perbellini PBPK model for -hexane is the only validated model for this chemical identified in the literature. The Fisher model was intended for risk assessment to predict which of 19 volatile organic chemicals may be present in milk at a high enough level after workplace exposure to raise health concerns for a nursing infant. 

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. 

Endrin has been detected in human breast milk (0.02-6.24 milligrams endrin in each kilogram milk fat [mg/kg]) this may be a route of exposure for nursing infants. However, no studies of endrin in breast milk in United States or Canadian populations have been conducted. 

The FDA and EPA recognize that the diets of infants and children may differ substantially from those of adults and that they consume more food for their size than adults. As a result, they may be exposed to proportionately more residues. The FDA and EPA address these differences by combining survey information on food consumption by nursing infants, non-nursing infants, and children with data on residues to estimate their dietary exposure. The FDA and EPA also use this process to estimate exposure for other age groups, as well as several different ethnic groups and regional populations. 

A statemenf thaf fhe particular freafmenf or procedure may involve risk to the participant (or to the embryo or fetus if the participant is, or may become, pregnant and to nursing infants) that is currently unforeseeable. 

Shi ZX, Wu YN, Li JG, Zhao YE, Eeng JE (2009) Dietary exposure assessment of Chinese adults and nursing infants to tetrabromobisphenol-A and hexabromocyclododecanes occurrence measurements in foods and human milk. Environ Sci Technol 43 4314 319... 

There have been no measurements of the levels of 1,4-dichlorobenzene or its metabolites in amniotic fluid, meconium, cord blood, or neonatal blood to investigate prenatal exposure. Consumption of breast milk can potentially expose nursing infants to 1,4-dichlorobenzene. Dichlorobenzene (all isomers) was detected in 100% of 42 samples of human breast milk collected in 5 urban areas of the United States at concentrations ranging from 0.04-68 ppb however, concentrations of 1,4-dichlorobenzene were not specified (Erickson et al. 1980). Dichlorobenzene (all isomers) was also identified in human breast milk in 8 of 12 women who were residents of Bayonne, New Jersey (6 women) Jersey City, New Jersey (2 women) Bridgeville, Pennsylvania (2 women) and Baton Rouge, Louisiana (2 women) however, concentrations of... 

Lactation It is not known whether lepirudin is excreted in breast milk. Because of the potential for serious adverse reactions in nursing infants, decide whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. 

Lactation Detectable amounts of progestins enter the milk of mothers receiving these agents. The effect on the nursing infant has not been determined. Medroxyprogesterone does not adversely affect lactation and may increase milk production and duration of lactation if given in the puerperium. 

Ectopic as well as intrauterine pregnancy may occur in contraceptive failures. Lactation Hormonal contraceptives may interfere with lactation, decreasing both the quantity and the quality of breast milk. A small amount of OC steroids is excreted in breast milk. A few adverse effects on the nursing infant have been reported, including jaundice and breast enlargement. 

Lactation Corticosteroids appear in breast milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other unwanted effects in the nursing infant. However, large doses for short periods may not harm the infant. Alternatives to consider include waiting 3 to 4 hours after the dose before breast-feeding and using prednisolone rather than prednisone. 

Lactation It is not known whether repaglinide is excreted in breast milk. Because the potential for hypoglycemia in nursing infants may exist, a decision should be made as to whether repaglinide should be discontinued in nursing mothers, or if mothers should discontinue nursing. 

Lactation Exercise caution when administering to a nursing woman. The possible lack of proper vitamin absorption may have an effect on nursing infants. 

Lactation Acetaminophen is excreted in breast milk. No adverse effects in nursing infants were reported. 

Lactation Because the effects of zaleplon on a nursing infant are not known, it is recommended that nursing mothers not take zaleplon. 

Lactation Nicotine passes freely into breast milk and has the potential for serious adverse reactions in nursing infants. 

Lactation It is not known if misoprostol acid is excreted in breast milk. Do not administer to nursing mothers because the potential excretion of misoprostol acid could cause significant diarrhea in nursing infants. 

Lactation Metoclopramide is excreted into breast milk and may concentrate at about twice the plasma level at 2 hours postdose. There appears to be no risk to the nursing infant with maternal doses less than or equal to 45 mg/day. 

Lactation Anthraquinone derivatives (eg, casanthranol, cascara sagrada, danthron) are excreted in breast milk resulting in a potential increased incidence of diarrhea in the nursing infant. Sennosides A and B (eg, senna) are not excreted in breast milk. It is not known whether docusate calcium, docusate potassium, docusate sodium, lactulose, and mineral oil are excreted in breast milk. 

Lactation Penicillins are excreted in breast milk in low concentrations use may cause diarrhea, candidiasis, or allergic response in the nursing infant. 

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