Neonatal Abstinence Syndrome (NAS)/Neonatal Opioid Withdrawal Syndrome (NOWS) Clinical Pathway – Inpatient – Additional Considerations For Use of Human Milk

Neonatal Abstinence Syndrome (NAS)/Neonatal Opioid Withdrawal Syndrome (NOWS) Clinical Pathway – Inpatient

Additional Considerations For Use of Human Milk

The Breastfeeding Traffic Light provides a summary of medications which are safe to take while breastfeeding, those for which there should be caution exercised, and medications and situations for which breastfeeding is contraindicated.

In addition, breastfeeding is contraindicated in the following scenarios:
  • HIV
    • The CDC advises against breastfeeding for HIV+ persons with a detectable viral load. A person receiving anti-retroviral therapy with sustained undetectable viral load during pregnancy and postpartum period with established follow-up should be supported but aware that while transmission is less than 1%, it is not zero.
  • Positive maternal urine toxicology testing for illicit substances at delivery and any of the following:
    • No confirmed plans for postpartum substance abuse treatment
    • No confirmed plans for pediatric care
    • Demonstration of behavioral qualities or other indicators of active substance use
    • Use of prescription medications that are contraindicated with breastfeeding
Breastfeeding is not contraindicated for the following:
  • Alcohol
    • Counsel mothers:
      • Limited or intermittent use is not a contraindication
      • Alcohol can be passed to the infant via breast milk
      • Women who consume limited alcohol should nurse prior to consumption,
        then wait at least 90-120 mins before breastfeeding to minimize exposure to the infant
      • Review with Lactation consultant
  • Tobacco
    • History of tobacco or nicotine replacement therapy is not a contraindication
    • Counsel mothers:
      • Limit infant’s exposure to cigarette smoke from all sources, including via contact with exposed clothing
      • Risk of Sudden Infant Death Syndrome (SIDS) may be increased
      • Nicotine and other substances can be passed to their infant via breast milk
      • Women should nurse their infant prior to smoking a cigarette
      • If they continue to use a nicotine patch while breastfeeding, discuss with their physician so that the lowest appropriate patch dose is selected

Additional Resources

For the most up-to-date information regarding infant exposure to these and other substances via breast milk. The Infant Risk Hotline can also be contacted: 1-806-352-2519.