Title: 359 NEONATAL APNEA AND MATERNAL CODEINE USE
Abstract: The occurrence of apnea in term and near term neonates is usually associated with a definitive organic etiology. We have recently studied 4 infants (x GA=37 wks, range 35-40 wks; x BW= 2660g, range 1980-3140g) with significant apnea and increased periodic breathing. All infants had been born by cesarean section (apgars 8/9) following uncomplicated perinatal courses and were well until 4-6 days of age when apnea developed. Complete bacteriologic, hematologic, metabolic, and cardiac evaluations were normal. Cardiorespirograms were abnormal showing multiple episodes of short apnea (5–10 sec x=25.5, range 15–39; 10-15 secs x=23, range 10-35) and increased periodic breathing (x=16.3%, range 1-35%). One episode of prolonged apnea (>20 secs) and multiple bradycardias were seen in one patient. All mothers had been breast feeding and receiving codeine 60 mg every 4–6 hours for analgesia. Breast feeding was held for 24 hours and the codeine discontinued. Codeine was not detected in the serum of one infant. Apnea resolved within 24–48 hours and the infants were discharged. Repeat cardiorespirograms within 7-10 days were normal. Experience in these 4 infants suggest: 1)Although only trace amounts of codeine are reported to enter breast milk, it may be sufficient to affect newborn respiratory control. 2)The metabolism of codeine in the newborn is uncertain. It may take 4–5 days for sufficient drug to accumulate and influence respiratory control. 3)Caution should be used with codeine administration in breast feeding mothers.