Breastfeeding Considerations for Mothers of Infants with Neonatal Abstinence Syndrome.

Breastfeeding offers many benefits to both mother and baby. Breastfeeding is generally recommended for mothers of infants with neonatal abstinence syndrome (NAS) unless some associated risk outweighs the benefits. Evidence indicates that infants with NAS who receive human milk require less pharmacologic treatment and have shorter hospital lengths of stay. Perhaps the greatest barrier to breastfeeding for women with opioid dependence is the inaccurate and inconsistent information they receive from different sources, including health care professionals. The American Congress of Obstetricians and Gynecologists, American Academy of Pediatrics, and Academy of Breastfeeding Medicine (ABM) have published statements that support breastfeeding infants with NAS. The ABM has a dedicated protocol to guide clinicians in deciding which mothers should and which mothers should not breastfeed their infants. In this review, studies evaluating the effects of breastfeeding, professional organizations' protocols and recommendations regarding breastfeeding, and barriers to breastfeeding infants with NAS are discussed, as well as the dangers of illicit drug exposure and avoiding rebound NAS in a breastfed infant. Clinicians can play an important role in in identifying, supporting, counseling, and advocating for mothers who wish to breastfeed their infant with NAS.

Effectiveness of ledipasvir/sofosbuvir in real-world patients with chronic hepatitis C: a collaborative treatment approach.

The effectiveness of ledipasvir/sofosbuvir (LDV/SOF) in routine use in clinical practice for the management of chronic hepatitis C virus (HCV) has not been well described. Data with prior agents suggest that management of HCV using an interprofessional approach in clinical practice is associated with better outcomes. This single-centre, prospective, observational cohort study evaluated patients treated with LDV/SOF for 8, 12 or 24 weeks as part of the standardized interprofessional treatment protocol at Novant Health Infectious Diseases Specialists. Eighty-four patients treated with LDV/SOF were evaluated; of these, 97.5% and 91.7% of patients achieved a sustained virological response (SVR) in the per-protocol analysis and the intention-to-treat analysis, respectively. Two patients were not cured after relapse of HCV. No patients required LDV/SOF discontinuation and all patients completed the appropriate treatment duration. The majority (56%) of patients reported no adverse effects and all adverse effects that were reported were mild. The most commonly reported adverse effects were headache and fatigue. SVR and tolerability rates were similar to those seen in the clinical trials. LDV/SOF was associated with a successful translation from the clinical trial setting to clinical practice. A collaborative treatment approach should be considered in the management of HCV.