What is the role of breastfeeding in the treatment of neonatal abstinence syndrome (NAS)?

Updated: Dec 20, 2017
  • Author: Ashraf H Hamdan, MD, MBBCh, MSc, MRCP, FAAP; Chief Editor: Santina A Zanelli, MD  more...
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Breastfeeding confers immunologic benefits to the neonate, and bonding benefits the mother. One study reported that only small amounts of methadone were detected in breast milk of women maintained on higher doses of methadone and recommended breast feeding for methadone-maintained women. [59] The benefits of breastfeeding often outweigh the effect of the small amount of methadone that enters the breast milk.

The previous recommendation of the American Academy of Pediatrics (AAP) was for mothers receiving maintenance doses of methadone more than 20 mg/24 h not to breastfeed. [60] However, the AAP now classifies methadone as compatible with breastfeeding. [61] The ACOG recommends that breastfeeding should be encouraged in patients without HIV who are not using additional drugs and who have no other contraindications. [62]

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used antidepressants in postpartum mothers. In general, SSRIs are well tolerated and effective for the mothers and probably are safe for their breastfeeding infants. Sertraline and paroxetine have minimal transfer into human milk and no adverse effects on infants. In contrast, fluoxetine produces significant plasma concentrations in some breastfed infants, especially if the exposure began in utero. Infant should be monitored closely for signs such as uneasy sleep, irritability, and poor feeding or sucking. [63, 64]

Enrollment in a drug rehabilitation program may be a prerequisite for breast feeding. Both marijuana and alcohol exposure through breast milk result in decreased motor development at age 1 year.

Breastfeeding is contraindicated if the mother is still using illicit drugs or has HIV infection.

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