Routine Morphine Infusion in Preterm Newborns Who Received Ventilatory Support

Simons, Sinno; Dijk, Monique van; Lingen, Richard A. van; Roofthooft, Daniella; Duivenvoorden, Hugo J.; Jongeneel, Niesje; Bunkers, Carin M.; Smink, Enna; Anand, K.J.S.; Anker, John N. van den; Tibboel, Dick

doi:10.1001/jama.290.18.2419

Cited by 276 publications

(265 citation statements)

References 63 publications

Supporting

Mentioning

243

Contrasting

Unclassified

Order By: Relevance

“…24 Two large randomized, controlled trials of the continuous use of intravenous morphine primarily as a potential means of decreasing poor neurologic outcome in preterm neonates receiving mechanical ventilation were published recently. 56,57 In both studies, additional openlabel morphine was allowed if infants were considered to be in pain. In the first study, 56 continuous morphine infusion was used for 7 days or less as clinically needed.…”

Section: Topical Anesthetic Pain Prevention For Minor Proceduresmentioning

confidence: 99%

“…56,57 In both studies, additional openlabel morphine was allowed if infants were considered to be in pain. In the first study, 56 continuous morphine infusion was used for 7 days or less as clinically needed. In this study, morphine had no apparent analgesic effect and did not alter the risk of a poor neurologic outcome (severe intraventricular hemorrhage [IVH], periventricular leukomalacia [PVL], or death).…”

Section: Topical Anesthetic Pain Prevention For Minor Proceduresmentioning

confidence: 99%

See 1 more Smart Citation

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

409

View full text Add to dashboard Cite

The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures. INTRODUCTION ObjectivesThis updated statement is intended for health care professionals who care for neonates (preterm to 1 month of age). The objectives are to:1. emphasize that despite increased awareness of the importance of pain prevention, neonates in the NICU continue to be exposed to numerous painful minor procedures daily as part of their routine care;2. present objective means of assessing neonatal pain by health care professionals;3. describe effective strategies to prevent and treat pain associated with routine minor procedures; and 4. review appropriate methods to prevent and treat pain associated with surgery and other major procedures. BackgroundThe prevention of pain in neonates is an expectation of parents. 1 However, there are major gaps in our knowledge regarding the most effective way to accomplish this. Although it may not be possible to completely eliminate pain in neonates, much can be done to reduce the amount and intensity of pain. The prevention of www.pediatrics.org/cgi

show abstract

Section: Topical Anesthetic Pain Prevention For Minor Proceduresmentioning

confidence: 99%

Section: Topical Anesthetic Pain Prevention For Minor Proceduresmentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

409

View full text Add to dashboard Cite

show abstract

“…261,262 In addition, continuous narcotic drips have little or no measurable impact on pain mitigation. [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.…”

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

View full text Add to dashboard Cite

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.

show abstract

“…This has led to increasing use of opioids in pediatric patients. Currently, human infants are routinely treated with opioids for pain relief and for the purposes of sedation to permit mechanical ventilation (van Dijk et al, 2002, Simons et al, 2003. With the observation of neonatal abstinence syndrome in 48-84% of infants administered intravenous opioids (Norton, 1988, Arnold et al, 1990, French and Nocera, 1994, Franck and Vilardi, 1995, Franck et al, 1998 it is imperative to assess whether tolerance, opioid-induced pain, and withdrawal pain are present in the pediatric population and whether opioid exposure alters normal synaptic development and produces long-term somatosensory changes Smith, 1998, Thornton et al, 2000).…”

Section: Author Manuscriptmentioning

confidence: 99%

Tolerance, opioid-induced allodynia and withdrawal associated allodynia in infant and young rats

Zissen,

Zhang,

McKelvy

et al. 2007

Neuroscience

View full text Add to dashboard Cite

Our laboratory has previously characterized age-dependent changes in nociception upon acute morphine withdrawal. This study characterizes changes in mechanical and thermal nociception following acute, intermittent, or continuous morphine administration in infant (postnatal day 5-8) and young (postnatal day 19-21). Morphine was given as a single acute administration (AM), intermittently twice a day for 3 days (IM), or continuously for 72 hours via a subcutaneous pump implanted (CM). AM did not produce long-term changes in mechanical or thermal nociception in either infant or young rats. CM produced changes in mechanical nociception that included the development of tolerance, opioid-induced mechanical allodynia and withdrawal-associated mechanical allodynia in young rats, but only tolerance and a prolonged withdrawal-associated mechanical allodynia in infant rats. IM produced withdrawal-associated mechanical allodynia in both infant and young rats. Measuring paw withdrawal responses to thermal stimuli, infant and young rats showed tolerance without opioid-induced thermal hyperalgesia or withdrawal-associated thermal hyperalgesia following CM. In contrast to CM, withdrawal-associated thermal hyperalgesia was seen in both ages following IM. In conclusion, CM versus IM differentially modified mechanical and thermal nociception, suggesting that opioid-dependent thermal hyperalgesia and mechanical allodynia can be dissociated from each other in infant and young rats. Furthermore, tolerance, opioidinduced hypersensitivity, and withdrawal-associated hypersensitivity are age-specific and may be mediated by distinct mechanisms.Keywords morphine withdrawal; spinal cord; allodynia; hyperalgesia; neonatal rat It has long been recognized that morphine exerts two paradoxical actions on the adult nervous system: the inhibition of pain processing manifested as analgesia and the facilitation of nociceptive sensitivity manifested as allodynia and hyperalgesia (Bederson et al., 1990, Kim et al., 1990, Kaplan and Fields, 1991. This facilitation of nociceptive sensitivity can be observed in as little as 20 min post-morphine administration by precipitating withdrawal with Corresponding Author: Sarah M. Sweitzer, PhD, Department of Pharmacology, Physiology, Neuroscience, University of South Carolina School of Medicine, Columbia, SC 29208, Phone: (803) Fax: (803) 733-1523 Email: sweitzer@med.sc.edu. Section Editor: Dr. Donna Hammond Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptNeuroscience. Author manuscript; available in PMC 2008 January 5. (Bede...

show abstract

Routine Morphine Infusion in Preterm Newborns Who Received Ventilatory Support

Cited by 276 publications

References 63 publications

Prevention and Management of Pain in the Neonate: An Update

Prevention and Management of Pain in the Neonate: An Update

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

Tolerance, opioid-induced allodynia and withdrawal associated allodynia in infant and young rats

Contact Info

Product

Resources

About