Central nervous system depression of neonates breastfed by mothers receiving oxycodone for postpartum analgesia

J Pediatr. 2012 Jan;160(1):33-7.e2. doi: 10.1016/j.jpeds.2011.06.050. Epub 2011 Aug 31.

Abstract

Objective: To quantify the incidence of central nervous system (CNS) depression in neonates breastfed by mothers medicated with oxycodone as compared with neonates whose breastfeeding mothers used codeine or acetaminophen only.

Study design: We retrospectively compared 3 cohorts in 533 breastfeeding mother-infant pairs exposed to oxycodone (n = 139), codeine (n = 210), or acetaminophen only (n = 184). Standardized questionnaires were administered to mothers during the postpartum period to identify maternal and neonatal health outcomes temporally related to analgesia exposure.

Results: Maternal exposure to oxycodone during breastfeeding was associated with a 20.1% rate of infant CNS depression (28/139) compared with 0.5% in the acetaminophen group (1/184; P < .0001; OR, 46.16; 95% CI, 6.2-344.2) and 16.7% in the codeine group (35/210; P > .05; OR, 0.79; 95% CI, 0.46-1.38). Mothers of neonates with symptoms in the oxycodone and codeine cohorts took significantly higher doses of medication compared with mothers of infants with no symptoms in the same cohorts (P = .0005 oxycodone; median, 0.4 mg/kg/day; range, 0.03-4.06 mg/kg/day versus median, 0.15 mg/kg/day; range, 0.02-2.25 mg/kg/day; codeine P < .001; median, 1.4 mg/kg/day; range, 0.7-10.5 mg/kg/day versus 0.9 mg/kg/day; range, 0.18-5.8 mg/kg/day). Mothers were significantly more likely to experience sedative adverse effects from oxycodone as compared with codeine (P < .0001; OR, 17.62; 95% CI, 9.95-31.21).

Conclusion: Oxycodone is not a safer alternative to codeine in breastfed infants.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetaminophen / adverse effects*
  • Adult
  • Analgesia*
  • Analgesics, Non-Narcotic / adverse effects*
  • Analgesics, Opioid / adverse effects*
  • Breast Feeding*
  • Central Nervous System / drug effects*
  • Codeine / adverse effects*
  • Female
  • Humans
  • Incidence
  • Infant, Newborn
  • Lethargy / chemically induced*
  • Lethargy / epidemiology
  • Oxycodone / adverse effects*
  • Postpartum Period*
  • Retrospective Studies

Substances

  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Acetaminophen
  • Oxycodone
  • Codeine