Infants with neonatal alloimmune thrombocytopenia are at risk of severe intracranial haemorrhage. Placental transfer of maternal immunoglobulin G (IgG) directed against fetal platelet antigens is known to be the underlying mechanism. Since breast milk contains IgG it is theoretically possible that breast feeding of these infants could cause thrombocytopenia. The following case report shows that an infant with neonatal alloimmune thrombocytopenia may be safely breast fed, even when the breast milk contains the platelet specific antibody (HPA-1a).

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A previous study in our nursery has shown that theophylline by mouth is 83% bioavailable.1 As a dose reduction of 20% would theoretically be required to change from intravenous aminophylline to theophylline by mouth, we postulated that oral bioavailability would reduce the amount of drug systemically available by approximately the same amount and no dose reduction would be necessary. Therefore, we prospectively evaluated whether serum theophylline concentrations were altered when infants were changed from intravenous aminophylline to theophylline by mouth without dose reduction, and vice versa.Patients and methods Serum theophylline concentrations were measured in infants in whom the same doses of theophylline by mouth and intravenous aminophylline were given. Those who received intravenous aminophylline for long enough to achieve a steady state concentration (for this study, considered to be four days2 4) and who were subsequently changed to theophylline by mouth for a similar period were evaluated. Patients were excluded if they concurrently received erythromycin, phenobarbitone, phenytoin, cimetidine, or other drugs suspected of altering theophylline metabolism.5 Similarly, infants with asphyxia were excluded due to suspicion of altered theophylline clearance rates.2Intravenous aminophylline (David Bull Laboratories) was given as a 10 mgtkg loading dose over 15 minutes, and then a maintenance treatment of 2-5 mg/kg every 12 hours, begun 12 hours after the loading dose. When the infant tolerated enteral feeding, theophylline by mouth (Elixophylline, Schering) was ordered at the same dose and frequency as the most recent aminophylline prescription. Doses by mouth were given at the same time as milk feeds.Serum theophylline concentrations were determined 30 minutes before a dose by dry chemical assay (Ektachem 700, Eastman Kodak Company, Rochester, NY). An acceptable therapeutic range for our assay was 45-90 ,umol/l (8-16 ,ug/ml), with a desired concentration of 70 ,umol/l (12-5 ,ug/ml). Data were analysed using Student's t test (paired, two tailed). Patient characteristics Mean (SD)Median (range)Intravenous to oral route (n= 18) Birth weight

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