Oral morphine risky, offers no benefit in premature infants

  • Lancet

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Oral morphine at a dose of 100 μg/kg carries a strong risk for respiratory distress in nonventilated premature infants undergoing retinopathy of prematurity screening while offering no relief for acute pain from clinical procedures compared with placebo.  

Why this matters

  • A number of guidelines include oral morphine to treat acute pain in neonates, with suggested doses of 50-200 μg/kg.

Study design

  • 31 nonventilated prematurely born infants (gestational age, 34-42 weeks) requiring heel lancing and retinopathy of prematurity screening on the same occasion were evaluated.
  • Infants were randomly allocated to either 100 μg/kg oral morphine sulphate or placebo, 1 hour before the clinical procedure.
  • Funding: Wellcome Trust; National Institute for Health Research.

Key results

  • Behavioral pain score (Premature Infant Pain Profile-Revised, [PIPP-R], mean difference, 0.5; P=.66) and magnitude of noxious evoked brain activity after heel lancing (median difference, 0.25; P=.25) were not significantly different between morphine and placebo groups.
  • Requirement of respiratory support in 6 (risk difference, 0.3; P=.020) and 24 (risk difference, 0.3; P=.006) hours after the clinical procedure was significantly higher in the morphine vs the placebo group.

Limitations

  • Peak analgesic efficacy timing of oral morphine is unknown.

Coauthored with Antara Ghosh, PhD

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