Morphine clearance and effects in newborn infants in relation to gestational age

Saarenmaa, E

doi:10.1067/mcp.2000.108947

Cited by 62 publications

(41 citation statements)

References 28 publications

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“…The surgical procedure, which can induce haemodynamic perturbation, together with the effects of anaesthesia, may have attenuated the already low cerebral oxygenation. There is also evidence that the pharmacodynamics of medication, particularly opioids, are different during different postmenstrual and postnatal ages,23 24 giving rise to excessive sufentanyl levels in some extremely preterm patients. This could have had a negative impact on the blood pressure of these infants.…”

Section: Discussionmentioning

confidence: 99%

Is cerebral oxygen supply compromised in preterm infants undergoing surgical closure for patent ductus arteriosus?

Lemmers

Molenschot

Evens

et al. 2010

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Section: Discussionmentioning

confidence: 99%

Is cerebral oxygen supply compromised in preterm infants undergoing surgical closure for patent ductus arteriosus?

Lemmers

Molenschot

Evens

et al. 2010

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…In our small study population, we could not demonstrate a relationship between the observed changes in cerebral hemodynamics and oxygenation and GA or BW. However, since the clearance of midazolam [27] and morphine [28] is related to GA and BW, a correlation is imaginable.…”

Section: Discussionmentioning

confidence: 99%

Effects of Midazolam and Morphine on Cerebral Oxygenation and Hemodynamics in Ventilated Premature Infants

Velden¹,

Hopman²,

Klaessens³

et al. 2006

Neonatology

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Background: Midazolam sedation and morphine analgesia are commonly used in ventilated premature infants. Objectives: To evaluate the effects of midazolam versus morphine infusion on cerebral oxygenation and hemodynamics in ventilated premature infants. Methods: 11 patients (GA 26.6–33.0 weeks, BW 780–2,335 g) were sedated with midazolam (loading dose 0.2 mg/kg, maintenance 0.2 mg/kg/h) and 10 patients (GA 26.4–33.3 weeks, BW 842–1,955 g) were sedated with morphine (loading dose 0.05 mg/kg, maintenance 0.01 mg/kg/h). Changes in oxyhemoglobin (ΔcO₂Hb) and deoxyhemoglobin (ΔcHHb) were assessed using near infrared spectrophotometry. Changes in cHbD (= ΔcO₂Hb – ΔcHHb) reflect changes in cerebral blood oxygenation and changes in concentration of total hemoglobin (ΔctHb = ΔcO₂Hb + ΔcHHb) represent changes in cerebral blood volume (ΔCBV). Changes in cerebral blood flow velocity (ΔCBFV) were intermittently measured using Doppler ultrasound. Heart rate (HR), mean arterial blood pressure (MABP), arterial oxygen saturation (saO₂) and transcutaneous measured pO₂ (tcpO₂) and pCO₂ (tcpCO₂) were continuously registered. Statistical analyses were carried out using linear mixed models to account for the longitudinal character study design. Results: Within 15 min after the loading dose of midazolam, a decrease in saO_2,tcpO₂and cHbD was observed in 5/11 infants. In addition, a fall in MABP and CBFV was observed 15 min after midazolam administration. Immediately after morphine infusion a decrease in saO_2, tcpO₂and cHbD was observed in 6/10 infants. Furthermore, morphine infusion resulted in a persistent increase in CBV. Conclusions: Administration of midazolam and morphine in ventilated premature infants causes significant changes in cerebral oxygenation and hemodynamics, which might be harmful.

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“…31 Some studies suggest that babies require higher plasma concentrations than older children or adults to receive pain relief, 32 although other studies disagree. [33][34][35][36] In the past, morphine was thought to be a pure opioid agonist, but this theory was disproven long ago. 37 Morphine has a ceiling effect; after a certain therapeutic level has been reached, higher doses will produce more adverse effects rather than increased analgesia.…”

Section: Morphinementioning

confidence: 99%

Pharmacological approaches to the management of pain in the neonatal intensive care unit

Anand

2007

J Perinatol

103

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Effective and consistent management of neonatal pain remains a controversial issue.Premature infants are repeatedly subjected to painful tests and procedures or suffer painful conditions when they are most vulnerable. With different mechanisms transducing various types of pain the practice of 'one-drug fits all' becomes questionable.Clinicians must use the latest non-pharmacologic and pharmacologic therapies for effective management of neonatal pain, distress, or agitation. Pharmacologic strategies for dealing with neonatal pain in the neonatal intensive care unit are described. Opioid therapy, once considered the mainstay for neonatal analgesia, may not be as effective as previously thought. Morphine infusions do not alter the neurological outcomes of preterm neonates and may not be effective against acute pain. Alternative approaches with methadone, ketamine, or local anesthetics should be considered. Clinicians must understand the contextual circumstances underlying pain in individual neonates and tailor therapy accordingly, using the most current evidence related to neonatal pain assessment and management.

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Morphine clearance and effects in newborn infants in relation to gestational age

Abstract: Morphine should be used with caution in prematurely born infants because of its low clearance, which correlates with gestational age.

Cited by 62 publications

References 28 publications

Is cerebral oxygen supply compromised in preterm infants undergoing surgical closure for patent ductus arteriosus?

Is cerebral oxygen supply compromised in preterm infants undergoing surgical closure for patent ductus arteriosus?

Effects of Midazolam and Morphine on Cerebral Oxygenation and Hemodynamics in Ventilated Premature Infants

Pharmacological approaches to the management of pain in the neonatal intensive care unit

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