Working in the Pediatric ED will often make you the default expert in ALL realms of pediatrics. Even if the actual patient isn’t a child, the issue may revolve around concerns for a child… and you are the lucky one working in the Ped ED that day. For instance, is it safe for a breastfeeding mother to be given contrast dye for a radiologic study (perhaps your colleague has a concern for a post-partum pulmonary embolism in the mother). When asked this very question recently, I had no clue… but thankfully a resourceful colleague of mine (yes, I’m talking about you Dr. Dave Pearson) found the answer… so let me pass it on to you:
The administration of iodinated or gadolinium based contrast agents may be necessary in breastfeeding mothers. Naturally, we have concerns about how the contrast may affect the mother’s own health, but how does it affect the breastfeeding child?
1. Iodinated Contrast
⇒ Half-life is about 2 hours
⇒ Nearly 100% is cleared from the mother’s bloodstream within 24 hours.
⇒ It has low lipid solubility and, hence, less than 1% is excreted in the breastmilk.
⇒ The infant will absorb less than 1% of the excreted amount from its GI tract.
⇒ The expected absorbed dose would be less than 0.01% of the dose given to the mother, which would be less than 1% of the dose that the child would be given if undergoing the study its self.
(1) Provide this information so the mother can make an informed decision.
(2) It is safe for the child to continue to breastfeed after the mother is given iodinated contrast.
(3) If the mother prefers, she may abstain breastfeeding for 24 hours and discard that expressed milk over that time period.
⇒ See above (seriously… the numbers are about the same, if not even less concerning)
⇒ The expected dose absorbed by the breastfeeding infant would be less than 0.0004%
(1) Same as for Iodinated contrast
(2) It is safe to continue to breastfeeding, but the mother may opt to “pump and dump” for 24 hours.
American College of Radiology Committee on Drugs and Contrast Media. Administration of contrast medium to breastfeeding mothers. October 2001, Volume 57, Issue 10, pages 12-13.