[Neonatal abstinence syndrome due to kratom]. / Neonataal abstinentiesyndroom door kratom.

BACKGROUND: Kratom (Mitragyna speciosa) is a herbal product obtained from the tropical tree family 'Rubiaceae'. Kratom is available without prescription in several formulations. The active component mitragynine acts in high dose as a mu-opioid agonist. It is misconceived to be a safe alternative to conventional opioid drugs for the treatment of chronic pain. Therefore, maternal use of Kratom is not without risks as opioid use during pregnancy is associated with Neonatal Abstinence Syndrome (NAS). CASE DESCRIPTION: In this case report we describe a term neonate with severe NAS as a result of daily Kratom ingestion by the mother during pregnancy. Presence of mitragynine was confirmed in serum of the neonate. NAS was successfully treated with oral phenobarbital. CONCLUSION: Maternal Kratom use during pregnancy can cause severe NAS via in utero exposure. Physicians should be aware of the possible maternal use of Kratom in the case of a neonate with NAS. NAS as a result of maternal Kratom use can be effectively treated with oral phenobarbital.

Antibiotics and lactation: An overview of relative infant doses and a systematic assessment of clinical studies.

Breastfeeding is important for the development of the child. Many antibiotics are considered safe during breastfeeding. The aim of the study was to assess the quality of lactation studies with antibiotics using the FDA and International Lactation Consultant Association quality guidelines for lactation studies. The secondary goal was to determine the exposure of the breastfed infant to antibiotics in relation to bacterial resistance and the developing microbiome. A literature search was performed and the included studies were scored on methodology, parameters concerning maternal exposure to antibiotics, maternal plasma and milk sampling. The infant exposure has been calculated and expressed as a percentage of a normal infant therapeutic dose. Sixty-six studies were included in five antibiotic groups (broad-spectrum penicillin, cephalosporins, macrolides and lincosamides, quinolones and sulphonamides). Cephalosporins were the most studied group of antibiotics (n = 21). Fifteen studies met all the criteria of "mother exposure to antibiotic". Six studies met every criterion related to "plasma sampling". Only one case report met all listed criteria for lactation studies. The correct calculation of infant exposure to antibiotics via the milk:plasma ratio (AUC) varies between 13% for macrolides and 38% for broad-spectrum penicillin. The highest assessed exposure as a percentage of infant therapeutic dose was for metronidazole (11%). The studies meet to a limited extent with the quality standards for lactation research. The breastfed infants are exposed to a subtherapeutic concentration of antibiotics.