Breast milk oxycodone concentrations in mothers given oxycodone for post-Caesarean delivery pain management.

AIMS: Both effective analgesia and early breastfeeding play an important role in maternal and neonatal well-being after Caesarean delivery. We studied controlled-release oxycodone tablet treatment for postoperative pain management and determined the excretion of oxycodone into breast milk. METHODS: Controlled-release oxycodone/naloxone 10/5-mg tablets (n = 21) or controlled-release oxycodone 10-mg tablets (n = 22) were administered to mothers twice a day for the first 3 days after elective Caesarean delivery as a part of multimodal analgesia. Maternal plasma and breast milk samples were collected daily. Oxycodone, noroxycodone, oxymorphone and noroxymorphone concentrations were analysed with ultra-performance liquid chromatography-mass spectrometry. Maternal pain intensity was recorded with an 11-point Numeric Rating Scale (0-10). Neonatal oxycodone exposure was estimated by simulating five different exposure scenarios, including the highest possible exposure through breast milk. RESULTS: The mean oxycodone and noroxycodone milk-to-maternal plasma ratios were 3.2 and 3.0, respectively. A strong correlation was found between plasma and breast milk oxycodone (R2 = 0.87) and noroxycodone concentrations (R2 = 0.91). In the simulated highest neonatal exposure scenario, the neonate's maximum plasma concentration was estimated to be 5.4 ng/mL and the estimated weight-adjusted infant oxycodone dose was less than 10% of the maternal dose. Pain intensities were similarly low between the two treatment groups. CONCLUSIONS: The oxycodone dose received from colostrum and breast milk during the first three postoperative days after Caesarean delivery is assumed safe for healthy, term neonates, but in extreme cases it is possible for the neonate to receive a dose through breast milk that may elicit opioid effects.

Screening of developmental disorders in five-year-olds using the FTF (Five to Fifteen) questionnaire: a validation study.

The study examined the validity of the Five to Fifteen (FTF) questionnaire in detecting developmental disorders in five-year-old children. A pilot study (N=70) was first undertaken to try out a translation of the FTF into Finnish. Subsequently, FTF questionnaires were mailed to parents of all five-year-old children from specified health-care districts in Vantaa, Finland. A total of 769 questionnaires (60%) were completed and returned. Children scoring above a cut-off value in any domain were considered at risk for having developmental disorders (the Risk Group; N=90). A Control Group was formed by randomly selecting 30 children who did not score above the threshold value in any domain. The children from the Risk Group and the Control Group were called to individual neuropsychological assessments. All invited children attended the assessments. The parts of the FTF that assess fine motor skills, executive functions (including attention and impulsivity), perception, memory, and language were used for this study. The external criterion measure was the NEPSY, a neuropsychological assessment instrument. Results demonstrated that the five FTF Domain Scores used in this study correlated significantly with the corresponding NEPSY Domain Scores. Second, the Risk Group obtained significantly poorer scores on the NEPSY than the Control Group. Third, on a cross-tabulation a very high rate of positive hits (93 %) was obtained as well as a very low rate of misses (7 %), indicating a very good sensitivity. However, there were a large percentage of false positives (63 %), indicating that specificity was not so good. Evidently, parents may report concerns related to the young child's development even when neuropsychological assessments do not indicate significant disorders. On the whole, the findings supported the validity of the FTF as a developmental screening instrument.