fentanyl Patch

[Mary C]

I am a hospital based IBCLC and have been following a family with a full term baby who is now 5 days old. Baby was placed in the NICU as mother has been on a fentanyl patch of 200mcg (changed every 2 days) for the last 2 years (for rheumatoid arthiritis and fibromalagia) and baby was going through withdrawal. Initially the mother was allowed to breastfeed her baby and has been breastfeeding and pumping. Now the neonatologist has asked mother to pump and dump as she has received information from our local children's hospital pharmacy that this dose is not safe. I could only find the 1 study cited in T. Hale's book about a woman on a fentanyl patch of 100mcg, so they are trying to wean mother down to 100mcg. Baby is on a low dose of morphine but is responding very well and should be weaned off the morphine (to counteract the withdrawal of pregnancy) within the next couple of days.
Our neonatologist is only willing to reconsider allowing baby back on breastmilk once mother is at 100mcg fentanyl patch or if I can produce a study with data regarding this higher dose. The mother is in the process of weaning. Are there any other studies regarding fentanyl patch?
Thank you

[admin]

Mary C:

Suggest the mom use a 50:50% mixture of human milk, and formula, until she can perhaps wean down. Or, start here and adjust upward ( say 75% HM, 25% formula, etc ) slowly so the infant can adapt to the fentanyl. Remember, we have infants breastfeeding with mothers taking more than 100 mg per day of methadone, and the babies do just fine.

Tom Hale Ph.D.