title: Randomised, double blind trial of two loading dose regimens of diamorphine in ventilated newborn infants.
abstract: OBJECTIVE
  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/kg were infused intravenously over 30 minutes, followed by a 15 mcg/kg/hour 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 mcg/kg loading dose seems to be safe and effective.
authors.affiliation: Department of Neonatal Medicine and Surgery, Nottingham City Hospital.
authors.forename: D P
authors.initials: DP
authors.lastname: Barker
authors.forename: J
authors.initials: J
authors.lastname: Simpson
authors.forename: M
authors.initials: M
authors.lastname: Pawula
authors.forename: D A
authors.initials: DA
authors.lastname: Barrett
authors.forename: P N
authors.initials: PN
authors.lastname: Shaw
authors.forename: N
authors.initials: N
authors.lastname: Rutter
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D003932:Heroin / Q000008:administration & dosage* / Q000494:pharmacology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007262:Infusions, Intravenous; D010146:Pain / Q000188:drug therapy; D012119:Respiration / Q000187:drug effects; D012121:Respiration, Artificial
chemical_list: D000701:Analgesics, Opioid; D003932:Heroin