Rx Note

Introduction Infantile colic is a benign, self-limited process in which a healthy infant has paroxysms of inconsolable crying . The standard diagnostic criteria - known as the "rule of three" (or Wessel Criteria) is crying more than 3 hours per day, more than 3 days per week, for longer than 3 weeks. Symptoms typically resolve by 3 to 6 months of age. NOTE: There is some evidence that a woman who smokes is more likely to have a baby with colic. Symptoms Colic symptoms may occur in up to 20% of infants. It usually starts between ages 2 and 6 weeks and occurs during the late afternoon or early evening at about the same time each day. The primary manifestation is recurrent crying episodes where the infant is very difficult to console, with fussiness, and/or irritability. Other symptoms may include Drawing arms and legs toward body, Turning red with crying, Burping and excessive flatus, Difficulty with passing stools, Tight fists, kicking, and arching of the back. The infa...

Introduction Human milk is the optimal source of nutrition and protection for newborn infants because of its proven health benefits for both infants and their mothers. Breastfeeding is associated with child health benefits including reduced risk for acute otitis media, gastrointestinal and other infections, and may be associated with reduced risk for atopic dermatitis and asthma . Maternal health benefits may include reduced risk of some chronic diseases and cancer. The World Health Organization recommends breastfeeding exclusively for the first 6 months of life and then continued with the addition of complementary foods for up to 2 years and beyond. Overview of Postpartum Care All infants should be placed skin-to-skin with the mother immediately after either vaginal or caesarean birth, unless medically contraindicated (e.g. if the mother or infant is medically unstable. During this period of skin-to-skin contact, a first attempt at breastfeedin g should be encouraged. Weighing, m...

Introduction Galactagogues are medications or other substances believed to assist initiation, maintenance or augmentation of maternal milk production. The routine use of galactagogues is not recommended because there is Limited evidence to support their efficacy Oral galactagogues (natural therapies or drugs) for increasing breast milk production in mothers of non-hospitalised term infants, 2020 Efficacy and Safety of Domperidone and Metoclopramide in Breastfeeding: A Systematic Review and Meta-Analysis, 2021 Because of potential safety concerns. Domperidone - risk of arrythmias Metoclopramide - CNS adverse effects and risk of tardive dyskinesia Hence, before initiating a galactagogue, women should attempt nonpharmacologic methods of increasing milk production such as Ensuring adequate hydration Skin-to-skin holding with baby Self-breast massage Relaxation techniques Unrestricted frequency and duration of breastfeeding Dosage Regimens The most commonly used prescription agents are dop...

Introduction Apart from drug safety in pregnancy , ensuring the safety of medications during breastfeeding is another important consideration. We are particularly concern about how much drugs are being passed onto the baby through breast milk. If it does, is there any concern on adverse effects? Nearly all drugs transfer into breast milk to some extent. Notable exceptions are heparin and insulin which are too large to cross biological membranes. As a general rule, breastfeeding is considered acceptable when the relative infant dose is <10%. In the past, package inserts were not always reliable sources of information regarding medication safety during lactation. However, the FDA published the Pregnancy and Lactation Labelling Rule (PLLR) on 3 December 2014, which requires data on medication transfer into breast milk to be included in the product inserts of prescription drug and biologic product applications submitted after 30 June 2015, while labelling for prescription drugs appro...

Introduction Since medicines taken by breastfeeding mothers may pass into breast milk, this article explores the safe use of over-the-counter medications while breastfeeding Medicines that passed into breast milk in small quantities rarely affects breastfed babies. Pain Paracetamol is considered compatible with breastfeeding when used in usual recommended doses to treat mild pain, such as headaches, toothaches, muscular pains or to reduce fever. NSAIDs are safe to help relieve pain and inflammation, but selective NSAIDs (COX-2 inhibitors) have limited data. Of the NSAIDs, ibuprofen is considered the drug of choice. Naproxen should be used cautiously in breastfeeding women due to its long half-life and has been documented to cause prolonged bleeding, anaemia and thrombocytopenia in a breastfed infant. Cough For a dry cough , a cough suppressant such as dextromethorphan is considered safe while breastfeeding. For a chesty cough , an expectorant such as guaifenesin or a mucolytic such ...

Introduction Hypertensive disorders during pregnancy affect approximately 8-10% of all pregnant women and the complications can be associated with significant morbidity and mortality to the mother and baby. Major Hypertensive Disorders Major hypertensive disorders that can occur in pregnant women are: Chronic hypertension Hypertension (BP >140/90) that exist before pregnancy or diagnosed in the first 20 weeks of gestation. Gestational hypertension New-onset of hypertension after 20 weeks gestation Preeclampsia Hypertension occur after 20 weeks gestation with features of multi-organ involvement Symptoms of pre-eclampsia include severe headache, problems with vision, severe pain below ribs, vomiting and sudden swelling of hands, feet or face accompanied with significant proteinuria and blood pressure greater than 140/90 mg Hg. In 2013, the American College of Obstetricians and Gynaecologists removed proteinuria as an essential criterion for diagnosis of preeclampsia. Eclampsia Ne...