385 - Opiates and Breastfeeding: A National Survey of Neonatal Intensive Care Unit Breast Milk Policies

Poster Number: 385
Publication Number: 385.102

Sarra Bae, University of Maryland Children's Hospital, Baltimore, MD, United States; Natalie Davis, University of Maryland School of Medicine, BALTIMORE, MD, United States

Background: In light of the ongoing opioid epidemic, opiate and substance use continue to be prevalent matters affecting the nation, including the pregnant and lactating population. Although controversy exists, the American Academy of Pediatrics (AAP) states that maternal substance use is not a “categorical contraindication” to breastfeeding and it may be encouraged for mothers enrolled in a supervised opioid maintenance program. However, breastfeeding is contraindicated in those still using illicit drugs due to concern over long term neurodevelopmental risks. Due to these concerns, we hypothesize wide variation exists in hospital breastfeeding policies for opiate positive mothers.

Objective: To perform a national survey of neonatal intensive care units (NICUs) regarding their breastfeeding/milk policy for mothers who test positive for opiates.

Design/Methods: We surveyed staff at level II-IV NICUs across the country, obtaining background data (location, level) and information on hospital policies for provision of breast milk based on toxicology screens positive for: 1) prescribed opiates, 2) non-prescribed opiates, 3) other non-prescribed illicit substances.

Results: We received responses from 39 NICUs in 20 states. [Table 1] The majority did not perform routine toxicology screening, but rather tested based on "provider discretion" (56%) or "maternal risk factors" (15%). Breast milk provision may be limited in 44% of NICUs (n=17) for positive opiate toxicology, with 94% (n=16) limiting breast milk only for non-prescribed opiates and 6% (n=1) limiting for all opiates including those prescribed by a healthcare provider. For mothers positive for their prescribed/maintenance opiates, 5% of NICUs (n=2) prohibit all breast milk and 3% (n=1) will not provide lactation consultation. For women positive for non-prescribed opiates, 62% of NICUs (n=24) prohibit all breast milk, 33% will prohibit breast milk until repeat toxicology is negative (n=13), and 8% (n=3) have no restrictions on breast milk use.

Conclusion(s): In this ongoing national survey, we found wide variation among NICUs in regard to breastfeeding policies for mothers who test positive for opiates. Consistent with AAP guidelines, there are fewer limitations for mothers who use prescribed opiates, though they still exist. However, for mothers positive for non-prescribed opiates, interventions range from fully prohibiting breastfeeding to fully allowing breastfeeding with no limitations. This variation in policies leads to inconsistent care across the nation and more research in needed to address the discrepancies in healthcare.
Table 1. Opiates and BF.jpeg