IBCLC Detailed Content Outline: Pharmacology and Toxicology Focused CERPs - Section IV

This presentation will focus on the pharmacodynamic and pharmacokinetic principles in neonatal populations and the implications for medication selection and monitoring. We will discuss parameters related to these principles and how pharmacotherapeutic regimens are determined using them. Absorption, distribution, metabolism, and elimination of medications and the clinical impact of neonatal patient characteristics and medication properties on pharmacotherapeutic decisions will also be presented. We will also contrast medications and why medications may be preferred for some neonatal disease states due to medication characteristics. The information provided will act as a foundation for pharmacotherapeutic recommendations based on patient and mediation specific properties for neonatal disease states.

There are many causes of hemodynamic instability in the neonate, with up to half of very low birth weight (VLBW) infants exhibiting evidence of low cardiac output and poor myocardial contractility within the first 12 hours of life. Failure to appropriately identify and address the causes of hypotension can lead to dramatic consequences in this vulnerable population. Pharmacotherapy is employed to provide action at specific receptors that result in improved cardiac output, relaxation and vasodilation of smooth muscle, as well as specific effects on the kidneys. Although the common agents have been used for decades, there are new developments in therapy. Refinements on patient selection, managing expected side effects, and effective dosing and have continued to evolve.

Caffeine is one of the most prescribed medications within the neonatal intensive care unit (NICU). This presentation will summarize the current understanding of caffeine therapy in neonates including the various indications. Caffeine is the medication of choice for apnea of prematurity (AOP) however it has been shown to be beneficial in several other disease states and conditions. Despite the widespread use of caffeine, there is not consensus on optimal dosing regimen or timing. We will review the supporting literature for the nuances of caffeine dosing regimens and schedules. While caffeine is generally considered a safe medication, we will also discuss potential side effects for monitoring. After this presentation, the audience will have a full picture of the pros and cons of this ubiquitous medication in our NICU population.

The lifetime risk of seizures is highest in the neonatal period. While the etiology of neonatal seizures is commonly the result of acute brain injury, other possibilities exist. Unfortunately, the need to treat neonatal seizures with anti-epileptic therapies or the timing and duration of therapeutic management is still vastly unknown. While phenobarbital has long been considered the mainstay of first-line medical therapy for neonatal seizures, newer agents are increasing in their popularity due to fewer side effects and concerns regarding potential neuronal apoptosis with phenobarbital. This presentation will discuss the etiology, need and timing for therapeutic management, compare and contrast various anti-epileptic therapies, and first-line, second-line, and therapies following initial failure for neonatal seizures.

To fully support their clients’ health throughout gestation, birth, and nursing, midwives need to know about herbs. Not a lot; in fact, what most midwives need to know can be learned in few hours. Wise use of herbs is especially important during pregnancy and lactation. Using herbs instead of drugs to allay problems protects both mom and fetus from harm. Even more importantly, the abundant nutrition available from select herbs – like stinging nettle, oatstraw, comfrey leaf, and red clover blossoms–has a much more profound influence on maternal health than any supplement and can make the difference between an easy birth and a complicated one. Herbal medicine is simple, safe, and effective at all times in a woman’s life, including during her childbearing years. Here are the things I think it most important that a midwife know about herbs and herbal medicine.

It is quite apparent that in our current society, pregnant and breastfeeding women do use and ingest recreational substances (in both a wisely manner and unwisely manner) and drugs of abuse, natural and/or synthetic. Marijuana use is of special concern currently, especially considering the ethical and legal concerns of its use. The objectives of this presentation are to effectively evaluate recreational drug use during breastfeeding and pregnancy; to counsel mothers who are pregnant or breastfeeding and using recreational drugs, including marijuana; and to discuss and address ethical concerns regarding marijuana use.

Between the 2000 and 2009, the use of opioids, such as heroin or prescription pain relievers, during pregnancy increased fivefold. Prenatal opioid exposure can result in newborn withdrawal symptoms often called Neonatal Abstinence Syndrome (NAS). NAS can include inconsolable crying, sleeplessness, and poor feeding. National rates of NAS have tripled since 2000. Opioid detoxification during pregnancy is not recommended and is linked to preterm labor and fetal distress. Therefore, it is recommended that pregnant women with opioid use disorder be stabilized on medication assisted treatment (MAT). However, these medications may still result in newborn withdrawal.
Treatment of NAS is typically focused on symptom management using soothing techniques and medications. Soothing techniques are non-pharmacological comfort measures and are considered the first line of care for infants with NAS. However, these techniques can be difficult to implement in a busy nursery environment. Medications may alleviate some NAS symptoms but, the use of medication is linked to a longer and more costly hospital stay and prolonged separation of mother and infant. As such, the purpose of this presentation is to explore best practices in the care of the opioid impacted mother-infant dyad with an emphasis on the important role of the biological mother.

This presentation will provide a general overview of neonatal abstinence syndrome (NAS) followed by a more detailed discussion of some of the more recently published approaches to treatment. This will include review of alternative dosing strategies for morphine as well as the use of buprenorphine for management of NAS symptoms.

This presentation would start with a brief explanation of what homeopathy is, how it works and why it is safe for mother and infant (over the counter ). I will give info on remedy use for nausea of pregnancy, threatened miscarriage, insomnia, mal-positioning, emotional upsets/fear of giving birth/grief/post partum depression, physical trauma of giving birth, prevention of prolonged labor, natural induction, after-pains, mastitis, engorgement, jaundice, milk supply problems. I will include how remedies are dosed and administered for mother and infant.

The impact of breastfeeding on fertility has been neglected by research in recent years. There can be significant variation in when the menstrual cycle returns for parents, which can impact their plans for family expansion. Some who conceived easily before breastfeeding, can find it much more difficult to conceive while breastfeeding. Some who struggle with recurrent miscarriage can wonder if breastfeeding is impacting their ability to carry to term. Many are left wondering whether to wean their nursling in order to conceive again, which can be a very difficult decision to make, when that conception is uncertain. This presentation will review the research on how breastfeeding affects the menstrual cycle, how fertility is initially suppressed and how it returns, the ongoing effect that breastfeeding can have on fertility, how to use breastfeeding as a contraceptive method (if desired), how to maximise chances of conception (if desired) and whether it may affect a pregnancy after conception has occurred.