Comment by mlyle

The original death finding falls just from simple back-of-napkin math.

87 ng/mL.

Baby eats 30mL per hour. That's 2.6 micrograms of morphine.

Elimination half life in neonates of ~8 hours means 30 micrograms in system at equilibrium if constantly fed this and the baby absorbs all of it (takes 4-5 half lives to get to that) and pharmacokinetics are linear. In reality a neonate likely absorbs well under 1/3rd, so you'd expect under 10 micrograms in equilibrium.

25-50 micrograms/kilogram is normal dosing of morphine in a neonate when it is necessary, every 6 hours (resulting in a peak systemic concentration of ~60-120 ug/kg after repeated dosing).

Compare -- 60-120 ug/kg therapeutic dosing to 10 micrograms in the neonate's body (3-4 kilos, so 3 ug/kg??)

And then, you end up with acetaminophen and codeine in the neonate's stomach, with no morphine... Even though these do not end up in breast milk in significant quantities.