Randomised, double blind trial of two loading dose regimens of diamorphine in ventilated newborn infants.

Abstract

Aims-To compare the safety and efficacy of two loading doses of diamorphine in 27 ventilated newborn infants in a randomised double blind trial. Methods-Fifty or 200 mcg/lkg were infused intravenously over 30 minutes, followed by a 15 mcg/kgthour continuous infusion. Serial measurements were made of physiology, behaviour, and stress hormones. Results-Both loading doses produced small but significant falls in blood pressure. The 200 mcg/kg dose produced greater respiratory depression, and two infants deteriorated clinically, requiring resuscitation. Loading reduced respiratory effort in most of the infants, but had little effect on behavioural activity. Stress hormone concentrations were reduced at six hours in both dosage groups; differences between loading doses were not significant. Morphine, morphine-3-glucuronide, and morphine-6-glucuronide were detected in the plasma of all patients. No significant differences in concentrations between loading doses were found. Conclusions-Diamorphine reduces the stress response in ventilated newborn infants. A high loading dose confers no benefit, and may produce undesirable physiological effects. A 50 mcglkg loading dose seems to be safe and effective. (Arch Dis Child 1995; 73: F22-F26)

Randomised double blind trial of morphine versus diamorphine for sedation of preterm neonates

“…Similar reductions in adrenaline and noradrenaline have recently been reported with the use of diamorphine, although two different doses of diamorphine seemed to have differing effects on the two hormones 13. We have confirmed that diamorphine and morphine infusions both significantly reduce the plasma concentration of adrenaline over the first 24 hours of infusion at the doses used.…”

“…We did not see this effect in association with the use of diamorphine given by an infusion regimen designed to give a clinically comparable sedative effect based on previously published studies. A small but significant fall in blood pressure has been reported using diamorphine before, but that was associated with either a 50 or 200 mcg/kg loading dose given over 30 minutes 13. In our study a 120 mcg/kg loading dose over 2 hours did not have any significant hypotensive effect and we calculate that this study had >90% power to detect a 10% (3.5 mm Hg) change in blood pressure for this group at a 5% significance level.…”

Opioids for neonates receiving mechanical ventilation: a systematic review and meta-analysis

“…The literature search identified 16 potentially relevant studies, of which 3 were excluded because they compared 1 opioid to another25–27 (figure 1). Thus, 13 studies described in 21 reports were eligible for review28–47 (table 1).…”

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

“…1,7 Previous studies reported that hypotension in the first 24 hours was affected by multiple clinical factors, including prenatal steroids, 31,32 gestational age, 33,34 severity of illness, 15,30,35 postnatal age in hours, 36,37 and morphine therapy. 38,39 We now know that hypotension can lead to decreased cerebral perfusion among neonates with either impaired or intact cerebral autoregulation. 1,4 Among neonates with impaired autoregulation, cerebral perfusion is pressure passive and hypotension decreases cerebral blood flow.…”