Morphine, Hypotension, and Adverse Outcomes Among Preterm Neonates: Who’s to Blame? Secondary Results From the NEOPAIN Trial

Hall, Richard; Kronsberg, Shari S.; Barton, Bruce; Kaiser, Jeffrey R.; Anand, K.J.S.

doi:10.1542/peds.2004-1398

Cited by 157 publications

(95 citation statements)

References 54 publications

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“…Hypotension has also been associated with morphine infusions in previous trials, 11,17 where the incidence was greater than 25% among preterm infants in the first 24 h of morphine infusion and in those who were hypotensive before morphine therapy. Our findings here may represent a more mature group of neonates, as in contrast to Anand's study all our study infants were greater than 36 weeks gestation.…”

Section: Discussionmentioning

confidence: 94%

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Safety profile of morphine following surgery in neonates

et al. 2007

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Objective: To determine the effect of morphine on duration of mechanical ventilation, apnoea and hypotension among full-term neonates who underwent thoracic or abdominal surgery in a level III neonatal intensive care unit.Method: Medical records of 82 infants were reviewed retrospectively and data including patient demographics, clinical diagnosis, type of surgery, postoperative opioid administration, duration of mechanical ventilation, hypotension, apnoea and pain scores (premature infant pain profile (PIPP) score) were collected.Result: Sixty-two neonates (76%) received morphine following surgery as a continuous intravenous infusion during the postoperative period. Linear regression analysis showed that morphine dosage and duration were significantly associated with the duration of mechanical ventilation. An increase in morphine infusion rate by 10 mg kg À1 h À1 was associated with an increase in the duration of mechanical ventilation by 24 h (P<0.0001) and an increase in morphine duration of 1 hour was associated with a longer duration of mechanical ventilation by 38 min (P<0.0001). Logistic regression analysis showed no association between morphine infusion rate or duration and hypotension. Apnoea was not associated with morphine dosage or duration of infusion in neonates receiving morphine following extubation. Score on the PIPP correlated significantly with morphine infusion rate across time (r ¼ 0.47, P<0.01). Conclusion:Postoperative morphine dose and duration may prolong the duration of mechanical ventilation but there are no significant dosedependent effects on other parameters including apnoea or hypotension following extubation in term neonates. More research is needed to determine the safety profile of morphine for management of pain in nonventilated neonates.

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Section: Discussionmentioning

confidence: 94%

“…Opioids may be administered safely to neonates when a well-constructed pain management plan is implemented. 11 Morphine is the most commonly used opioid in this population.…”

Section: Introductionmentioning

confidence: 99%

Safety profile of morphine following surgery in neonates

et al. 2007

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“…[263][264][265] Fentanyl has been associated with hypothermia, chest wall rigidity, 266 and both morphine and fentanyl lead to increased length of stay associated with narcotic dependence. 267 Morphine has been associated with hypotension 268 and prolonged ventilatory support. 261,269 Increased ventilator days have been shown to be an independent risk factor for neurodevelopmental delay.…”

Section: To 32 Weeks Gestational Age and Beyondmentioning

confidence: 99%

The development of potentially better practices to support the neurodevelopment of infants in the NICU

et al. 2007

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Objective: To review the existing evidence used to identify potentially better care practices that support newborn brain development.Study Design: Literature review.Result: Sixteen potentially better practices are identified and grouped into two operational clinical bundles based upon timing for recommended implementation. Conclusion:Existing evidence supports the implementation of selected care practices that potentially may support newborn brain development.

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“…Pharmacological analgesic therapy may be associated with a high incidence of potentially harmful, systemic side-effects and may also alter development and increase cell death in the immature brain. 3,4 Nonpharmacological therapies, such as sucrose, massage, or kangaroo care, can reduce neonatal pain, but are relatively ineffective against severe acute pain.…”

Section: Introductionmentioning

confidence: 99%

Safety of Noninvasive Electrical Stimulation of Acupuncture Points During a Routine Neonatal Heel Stick

Kracht¹,

Yates

Mitchell

et al. 2015

Deutsche Zeitschrift für Akupunktur

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Background: Hospitalized infants may undergo frequent painful procedures with inadequate pain relief. Alternative pain relief interventions are needed. Objective: The aim of this research was to determine the safety of noninvasive electrical stimulation of acupuncture points (NESAP) in neonates who were receiving routine heel sticks. Design: This was a descriptive study performed to assess the safety of using a transcutaneous electrical nerve stimulation (TENS) unit to deliver NESAP to neonates. Setting/Subjects: The subjects were healthy newborn infants < 3 days old before hospital discharge. Intervention: The intervention was NESAP delivered via a TENS unit, administered before, during, and after heel stick. The electrodes of the TENS unit were applied at four acupuncture points. Settings were gradually increased: 6 infants received 1.0 mA, 2 Hz; the second 6 infants received 2.0 mA, 10 Hz; and the last 18 infants received 3.5 mA, 10 Hz. Main Outcome Measures: Three main measures were used: (1) skin assessment (2) vital signs; (3) pain scores using the Premature Infant Pain Profile (PIPP). Results: There were no significant changes in vital signs during and after NESAP. There were no changes in PIPP scores in the first 12 infants after initiation of NESAP. A slight but nonsignificant increase in PIPP scores (from 2.65 to 3.5 on a scale of 0-18) occurred in the last 18 infants. There were no adverse events during or after NESAP. Conclusions: NESAP is safe for infants with low settings on a TENS unit.

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Morphine, Hypotension, and Adverse Outcomes Among Preterm Neonates: Who’s to Blame? Secondary Results From the NEOPAIN Trial

Cited by 157 publications

References 54 publications

Safety profile of morphine following surgery in neonates

Safety profile of morphine following surgery in neonates

The development of potentially better practices to support the neurodevelopment of infants in the NICU

Safety of Noninvasive Electrical Stimulation of Acupuncture Points During a Routine Neonatal Heel Stick

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