Fludeoxuglucose F 18

[Nathalie Gagnon]

Hello,
In Mommymeds app and Medications and mother's milk, we can read this sentence: "The authors suggest pumping of the milk and feeding in bottles by another individual to reduce direct exposure to radiation."
So can the milk be pumped and then used to feed the baby in the first 10-12 hours after the injection, knowing that "The calculated maximum cumulative dose to the infant, 0.085 mSv with no interruption of breastfeeding, is well below the recommended limit of 1 mSv." M&MM 2021?
ABM Clinical Protocol #31 says: "FDG is not excreted into breast milk. Contact between the mother and child, however, should be limited for 12 hours after the injection of FDG due to radioactivity concentrated within the breast tissue itself. Milk can be expressed and safely given to the child during this time. The milk does not need to be discarded."
[url]https://www.bfmed.org/assets/31%20Radiology%20and%20Nuclear%20Medicine%20Studie s%20in%20Lactating%20Women.pdf[/url]
Can you help me to understand what is the right way to deal with this product?
Thank you.
Nathalie Gagnon

[kaytlin]

Hi Nathalie,

Yes, for 12 hours after the FDG mom can pump her milk and baby can consume that milk via a bottle/syringe. The risk is not in the milk. Direct feeding at the breast requires frequent prolonged direct contact with the infant that will expose the baby to the radiation in mom's body as it decays. This is why we limit infant-mother contact during this period.

Kaytlin Krutsch, PharmD

[Nathalie Gagnon]

Thank you so much for your answer.
It is sad to read in Medications and mother's milk to read: "Recommend pumping and dumping of breast milk after the procedure for at least 4-9 hours to minimize radiation.[6] Because the infant receives more radiation from close contact with the breast, close contact should probably be avoided for about 4 hours and minimized close contact for the next 10 hours, due to release of gamma radiation from the mother."
From what you answered, why dumping? And why "for the next 10 hours" after the initial 4 hours? The half-life is 110 minutes. So, the time after 5 half-lives (97% of the dose decayed away) is 9,2 hours and 6 half-lives (98,5% of the dose decayed away) to be caucious is 11 hours, not 14.
Wouldn't it be more accurate if we read: "Recommend pumping of breast milk after the procedure for at least 4-9 hours to minimize radiation, the milk given by another individual.[6] Because the infant receives more radiation from close contact with the breast, close contact should probably be avoided for about 4 hours and minimized close contact for the next 5 to 7 hours, due to release of gamma radiation from the mother."
I greatly appreciate your time. Thank you abd have a nice day.
Nathalie Gagnon, Gatineau hospital pharmacist

[kaytlin]

Hello! Just FYI - I'm updating the monograph so that the next edition of Hale's Medications and Mothers' Milk includes your suggestion. Thank you for pointing it out!