Breastfeeding and MRI scan - HELP please - Mears? Tiktok? Anyone?

[Nome]

I've posted this in Health as well.

Some background: I have a lump in my liver which was found after an ultrasound scan when I was 13 weeks pg. My consultant said to contact him after delivery and they would arrange an MRI scan to have a closer look and decde whether I need a biopsy.

dd was born by VBAC 10 days ago. I phoned up consultant's secretary and told her. Today I got an appointment for Tuesday. I phoned up the MRI department to check whether it would be ok to bring dd with me as I am breastfeeding and she is very new - she will be 14 days old on Tuesday. During the conversation, the radiographer says I should express and they will give her a bottle if she needs it during the examination. Then she says that if I need the dye, then I will not be able to breastfeed for 48 hours.

Now I can probably express enough for a couple of feeds between now and Tuesday midday, but I don't think I can express enough for 48 hours worth of new born feeds.

Does anyone know anything about the dye? Does it really take 48 hours? If it does I will have no choice but to give formula - does that mean the end of bf?

Help please - I am so hormonal I am in tears at the thought of not feeding her for 48 hours.

I am not an expert and can't comment on the 48 hours for the dye. But here's what I would do

• express as much as you can between now and then, but don't kill yourself. However much you can express is good.

• if you have to use formula, try and cup feed, therefore avoiding nipple confusion

• express if you are able after the scan to ensure your supply is maintained. You may not be able to use the milk though but the expressing will stimulate milk production

This definitely does not mean the end of breastfeeding. You can get through this, it will only be a couple of days.

Take care of yourself and I hope all goes well on Tuesday.

I've just read in the La Leche League bf answer book that there should be no probs with the dye but would say check with a pharmacist at the hospital
If it takes 48 hrs - express lots. Start now & you may well express enough for 48hrs of bf. A newborn as a stomach the size of a walnut!! Ask your doc for some suitable formula just in case. By expressing in the time you can't bf you'll still be helping establish your milk supply - so it will be fine to go back to bf afterwards. Best wishes xxx hope you'll be ok xxx

Thank you. I'm just off to set the sterilisor going for my breast pump.

Hope all goes well for you Nome - take care of yourself as this sounds like a difficult time. Soon it will be the day when you can bf next week if you can't before and it will be a super moment for you.

OK, I googled breastfeeding MRI Scan Dye Hale (Tom Hale is a dr who the world authority on drugs and breastfeeding) and though most medical sites suggest 24 hours of not breastfeeding (not 48) Tom Hale disagrees.
My links never work so apologies for the length of this.
Posted on Thursday, October 02, 2003 - 03:41 pm:

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Dear Dr. Hale,

I have been told (by the Hospital Radiologist) that the contrast for CT scans, Ommniscan (gadodiamide) and Teslascan (mangafodipir trisodium) is unsafe for lactating mothers. They tell lactating mothers to pump and discard milk for 24 to 48 hours. Do you have any information on these drugs.

Tom Hale Ph.D.
Member
Username: Tom
Post Number: 212
Registered: 04-2003
Posted on Thursday, October 02, 2003 - 04:26 pm:

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Teresa:

We do not have data on the other gadolinium salt, Omniscan (gadodiamide), but I doubt it's milk levels will be much different than that already published for Magnevist. Patients will have to choose how they approach breastfeeding after using this one...but I seriously doubt milk levels will be hardly detectable...just as with Magnevist. If mom wants to pump and discard after 4 hours, then most all risk would be eliminated.

As for Teslascan(mangafodipir), no data are available on its use in breastfeeding mothers as well. However, this is just a source of manganese, an element common in breastmilk anyway. While the manganese plasma levels in the mother would rise sharply after injection, most of it is back to baseline levels after an hour or so. I would not again be too worried about its use in breastfeeding mothers. If they want to again wait 4 hours, pump and discard any milk, almost all risk would be removed.

But it sure would be nice to have some studies on these agents in breastfeeding mothers.

Tom Hale, Ph.D.

Heidi H. Chavers
New member
Username: Hhc
Post Number: 1
Registered: 10-2003
Posted on Wednesday, October 29, 2003 - 11:33 am:

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A mother was told that to scan her neck and effectively distinguish between a lypoma and another new smaller tissue mass that they would use "Ultravist 300" (Iopromide) for the contrast medium during her CT scan. The information she was given was that she would need to pump and dump for 48 hours, post scan. I have had difficulty researching this med. She actually found information from the manufacturer which said that there had been no studies. Based on the composition of this drug, and any information you may have, does this seem accurate to you?
I told her that I would do my best to get any additional info.

Thanks as always,
HHC

Tom Hale Ph.D.
Member
Username: Tom
Post Number: 250
Registered: 04-2003
Posted on Wednesday, October 29, 2003 - 02:18 pm:

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Heidi:

Ultravist is just like all the other radiocontrast agents, in fast and out fast. All the others than have been studied, are virtually excluded from the milk compartment, AND they are not orally bioavailable to the infant via milk.

A brief one-time pumping a few hours after the procedure should eliminate all risks.

Tom Hale, PH.D.

PS: Check my book under radiopaque agents, and on page 752

Debbie DePaul
New member
Username: Dedepaul
Post Number: 1
Registered: 01-2004
Posted on Wednesday, January 28, 2004 - 08:35 am:

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What are the recommendations for the breatfeeding mom when Visopaque (Iodixanol) and Gastroview (Diatrizoate Meglumine)are used for a CT scan?

Margaret Joy Clayton
New member
Username: Megclaytonlll
Post Number: 1
Registered: 01-2004
Posted on Thursday, January 29, 2004 - 10:36 pm:

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Dear Dr. Hale,

Thank you so much for the forum! I was able to find the information very quickly and easily that I needed to help the mom who had called me the night before her procedure!

Sincerely,
Meg Clayton
LLL Leader

Julie Leung
New member
Username: Julie1174
Post Number: 1
Registered: 02-2004
Posted on Friday, February 20, 2004 - 08:49 am:

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Dear Dr. Hale,

I am so happy I found your website. I have not been able to locate the help I need to answer my questions. Any news on GADOLINIUM? I am scheduled for an MRI with contrast of the head and the bilateral internal auditory canals. I am a nursing mom, and my son is on antibiotics for an ear infection. To complicate things further, I believe I have a sinus infection (green mucus, pressure in sinuses and behind eyes, and lots of pressure in general), but am trying to hold off from antibiotics myself since my son is on them.
Thank you so much!

Tom Hale Ph.D.
Member
Username: Tom
Post Number: 436
Registered: 04-2003
Posted on Friday, February 20, 2004 - 01:21 pm:

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Julie:

Its on page 316 of my book. It has all the info you need.

Tom Hale, Ph.D.

michelle aduhene
New member
Username: Michelle29
Post Number: 1
Registered: 02-2004
Posted on Sunday, February 22, 2004 - 08:25 am:

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Dear Dr Hale,
Just a quick question. I have searched yr site and can't seem to find this drug. I have a mum who is due to be given xenetix 350. She believes it is a dye. She has renal kidney stones. She has been advised to wait 48 hours before breastfeeding. I have read a lot of yr answers to other queries and it seems this is over excessive. However I would like to check as I haven't found anything specific to this drug.
Thanks Michelle

Tom Hale Ph.D.
Member
Username: Tom
Post Number: 442
Registered: 04-2003
Posted on Sunday, February 22, 2004 - 08:52 am:

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Michelle:

You're correct, Xenetix 350 is just another iodinated contrast agent with a brief 1.8 hour half-life.

Its protein binding is 2.1%, volume of distribution is 0.2 L/kg which suggests it primarily stays in the plasma and extracellular spaces (probably not milk compartment). Iobitridol is excreted rapidly and in unchanged form via the kidneys; 88% to 93% of a dose is excreted in the urine in the first eight hours after administration and the dose is completely eliminated within 24 hours.

I don't see any reason for a 48 hour interruption of breastfeeding. In fact, there is probably no good reason to discontinue breastfeeding at all. But if the mom wants to be safer, she could pump and discard the first milk 3-4 hours following injection of the agent. This would greatly reduce any possible risk.

Further, it wouldn't be orally bioavailable to any degree in the infant.

Tom Hale, PH.d.

Helen Vermilya
New member
Username: Hvermilya
Post Number: 4
Registered: 06-2003
Posted on Thursday, April 01, 2004 - 11:20 pm:

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Dear Dr. Hale:
I saw a post on January 28, 2004 inquiring about Iodixanol (Visipaque), but did not note any reply. Over the past six weeks I have heard of at least three mothers who were told to stop breastfeeding folowing a CAT Scan. The one mother had a Lung Scan for a possible Pulmonary Embolism. If my understanding is correct Omnipaque or Visipaque was the radiocontrast used. I thought that Visipaque was compatible, but the OB/Gyn doctor ordered her to pump and dump for 48 hours and the radiologist ordered 24 hours. The OB/Gyn did then change his order to 24 hours.
If they are compatible I want to send a FYI to the physicians and radiologists.
Thank you for your time.
Helen

Tom Hale Ph.D.
Member
Username: Tom
Post Number: 475
Registered: 04-2003
Posted on Friday, April 02, 2004 - 11:44 am:

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Helen:

Visipaque (iodixanol) is not that different for any of the 100 or more other radiocontrast agents. In fact, its molecular weight is even higher than others (1550 daltons). Its even less likely to enter milk than the others. The manufacturer gives the same statement that they don't know if it enters milk or not. The elimination half-life is only 2.1 hours.

There is no reason to assume this agent is any more toxic than all the other radiocontrast agents. It should not be a problem for breastfeeding mothers or their infants. Again, if they want to pump and discard once after the procedure (4 hours), it would virtually eliminate any possible risk.

Tom Hale, Ph.D.

Brenda Whetstone
New member
Username: Bewwes
Post Number: 3
Registered: 01-2004
Posted on Friday, May 28, 2004 - 10:01 am:

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Our Radiology department uses Omnipaque, and Omniscan and they tell me they use 150mL instead of the 10-75mL the book mentions for Omnipaque. Does this change your recomendations for its use in breastfeeding mothers? Would you recomend pump and dump 4 hours after the procedure?

Tom Hale Ph.D.
Member
Username: Tom
Post Number: 598
Registered: 04-2003
Posted on Friday, May 28, 2004 - 02:11 pm:

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Brenda:

I generally recommend a single pump and discarding after radiocontrast agents anyway...so your suggestion at 4 hours is just fine.

TWH

Thanks Aloha, I was getting nowhere fast with Google.

I have contacted the MRI dept again and they use 10ml of Gadolinium (Magnavist).

My midwife has given me the LLL number and apart from that she can only suggest formula or putting off the scan.

I am feeling so hormonal and weepy and stupid.

The Breastfeeding Network usually give sensible advice too

Poor you. You aren't silly at all. I would cry too. Esp as you must be worried about yourself as well as the breastfeeding. However, I really think 48 hours sounds too long. No US sites suggest that long - just 24hours - and Hale really is the top authority on drug interaction with breastmilk. Hardly anyone else knows anything about it and say things like 48 hours because they don't know.
And even if you do use formula for a couple of feeds it really isn't he end of breastfeeding. My ds was given formula in hospital and afterwards and I fed him for over a year.

Nome - when we have had women going for scan with dye, the advice has been 24 hours. TBH I would go with what Thomas Hale says. The people working in these depts don't really know wheras he is the expert. I would express milk just now and bank as much as you can.I would really think 24 hours is more than enough. Remember he says waiting 4 hours and dumping would probably be enough. 24 hours gives you a huge window.

Hopefully LLL or Tiktok will have more knowledge.

Definately does not mean the end of breastfeeding if you have to give some formula. Just start expressing small amounts throughout the day and you will find it soom mounts up. If you drip milk form one side when feeding, catch it in a breast shell. I always expressed between feeds - never after because I didn't get much. Any time you feel full express some off. Don't worry if baby then wakes immediately after for a feed because you will still have plenty.

Take baby with you and feed her as close to examination as possible then you won't need to use up any of your store. HTH.

found this info which says 24 hours

Thank you everyone. I hate feeling like this. dd is so little (well, 4kg, but you know what I mean) and feeding is going so well, I just don't want to mess it up. I've managed to express 3oz this morning - any ideas on how much she should have in a bottle? As much as can be crammed in, or is there a suggested amount?

I had my gallbladder removed suddenly when ds was 4 weeks old and I can remember how I was given different advice on pump and throw by every doctor involved.

If you're bagging it, make up small bags. 3oz is lots. I think small babies tend to have (at most) 4oz or so?

And you can always do one small bottle, then another. Whereas if a big bottle is warmed up, it has to be tossed afterwards.

Nome, sorry to hear you're having such a worrying time

I would just say that I've not met one health professional who has had any knowledge about breastfeeding - I have, however, met doctors, nurses, midwives and health visitors who are totally ignorant about it.

The ones you see are likely to be erring on the side of extreme caution from a position of total ignorance. Go with the info on this thread or ring the Breastfeeding Network's Drugline (link further down this thread) - these are people who know about breastfeeding.

Also, for expressing purposes - if you can feed with DD under one arm in the rugby hold and express on the other side, you may well get loads (letdown can be v forceful on the other boob while feeding - hence leakages!). As for amounts - DS was drinking 6 or 7 oz of breastmilk when he was 6 months old and not eating solid food, so I cannot imagine that you will need more than 4oz per feed.

Hope that the procedure goes well and speedily xxxxxxxxx

Can I just clarify - I have met some very knowledgeable and supportive HPs on here, just not in RL

Nome, I had a renal scan a few weeks ago and was also given the dye. I was told that it may affect the taste of the milk but they weren't concerned about me feeding dd. They said if I was worried then maybe I could feed her formula for 24/48 hours. I expressed enough for 24 and then went back to feeding her as normal. They said the dye should be out of your system after a few hours. Hth.

Decided to express what I can and feed that to dd for four hours after the scan. I am trying not to feel like I am failing her now... Hopefully the benefits of bf will outweigh the minute traces of gadolinium she will get.

Sigh. Whatever I do will be wrong for someone, won't it?

Thank you for all your help yesterday - I am feeling a lot calmer about it all today.

Nome, you are NOT failing her! If you weren't bothered about whether she fed or not, that would be different. But the fact that you're worrying about it means you are wonderful, I promise. Now concentrate on your scan, giving DD cuddles and there's every chance she won't need any EBM - or at the very most a few ounces.

Funny isn't it? The kerfuffle over expressing for 48 hours had made me completely forget I've got a lump in my liver!

I've got 9oz of Nome Gold top stashed in the freezer now - should have almost a pint and a half by Tuesday midday - that's enough to make ice-cream I think, perhaps Crema della Noma?

9 oz is loads for four hours! You're doing very well on expressing, obviously your supply is very good.

And please don't worry. The dye is meant to stick around, be visible on the MRI, and then go away, right? So I doubt ingesting any tiny quantity she gets will do her any harm.

9 oz is fantastic! It's taken me about 4 weeks to get that much (getting a bit better at it now). Really well done.

Not sure how much this helps, but we did an experiment yesterday to see how much ds weighed before and after a feed. Never done this before btw, but have daft situation where have to go back to work for two days and need to know how much EBM to provide. ds is 12 weeks and took almost exactly 4 oz, so would guess your dd won't need more than that.

Best of luck with the scan.

Also meant to say I know exactly how you feel about being upset at the thought of not being able to feed. I didn't have anywhere near as good a reason as you and I was still really upset about it.

A short update:
I had the scan yesterday and because the consultant was on hand to check the images, they didn't have to do them again with the dye 'just' in case'. I am so relieved. I have a pint of EBM in the freezer waiting for the next panic.

Thank you for all your help and kind words over the last couple of days.

Glad to hear it Nome. You could have a good few nights out on your stash

BTW - is your liver OK?

I don't know yet - now I have to wait for my liver consultant to have a look at the images and decide what he wants to do. I'm hoping for a letter saying interesting but trivial, we'll scan you again in a year to be sure, we don't need to see you till then!

Rosie slept from getting in her carseat to go down to the hospital to arriving back home again four hours later. Grr. Whay won't she do this at night?? Seriously though, it was impossible to insert nipple into her tightly clenched mouth and get her to feed.

BTW, mears, I went for a VBAC after reading your advice on various threads, and I followed your advice and was v. lucky and had a straightforard delivery. The MIDIRs links were especially useful. Thank you. I would have opted for a section if I hadn't read your advice.