Safety profile of morphine following surgery in neonates

Abstract

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.

Procedural Pain and Oxidative Stress in Premature Neonates

“…Because neonates are exposed to multiple painful procedures per day 13, 28 , previous investigations have focused on examining and decreasing the painful effects of these procedures. A number of interventions, such as the use of sucrose 1, 9, 27 , pacifiers 2, 9 , or morphine 3, 20 have been successful in decreasing signs of pain, but studies investigating the possible biochemical sequelae of painful procedures in neonates are needed. If exposure to multiple painful procedures is shown to contribute to oxidative stress, biochemical markers of such stress might be useful in evaluating mechanism-based interventions that could decrease the adverse effects of exposure to these procedures.…”

Pain Management in Newborns

“…A retrospective study of 62 ventilated term newborns found that postoperative morphine infusions prolonged the need for mechanical ventilation, but was not associated with apnea, hypotension, or other complications 123 . A series of RCTs comparing intermittent vs. continuous morphine infusions found that morphine is safe and effective for postoperative pain in term neonates and older infants 124-130 .…”

Long‐term effect of morphine administration in young rats on the analgesic opioid response in adult life

“…Neonates, infants and children are often exposed to pain from invasive procedures during intensive care and during the post‐operative period (Pattinson and Fitzgerald, 2004). The use of opioid analgesia has increased in the Neonatal Intensive Care Unit (NICU) in the last decades as a consequence of the changes and advances in the understanding, identification, and treatment of pain in children (El Sayed et al, 2007). However, there is still a lack of knowledge on their specific effects in a long‐term administration for this population of patients (Marsh et al, 1997).…”