title: Randomised double blind trial of morphine versus diamorphine for sedation of preterm neonates.
abstract: OBJECTIVE
  To compare the safety and effectiveness of morphine and diamorphine for the sedation of ventilated preterm neonates in a double blind, randomised trial.
  
  
  METHODS
  Eighty eight babies were allocated to receive either morphine (n = 44) or diamorphine (n = 44) by bolus infusion (200 or 120 mcg/kg, respectively, over two hours), followed by maintenance infusion (25 or 15 mcg/kg/h, respectively) during the initial phase of their respiratory disease. Serial monitoring of physiological, behavioural, and biochemical variables over the first 24 hours of the infusions was performed. Longer term outcomes were also monitored.
  
  
  RESULTS
  Morphine, but not diamorphine, was associated with a mean (SEM) decrease in mean arterial blood pressure of 2.2 (1.0) mm Hg (p = 0.05) over the initial loading infusion. Physiological (blood pressure variability) and behavioural measures of sedation (clinical assessment and sedation scoring) indicated that the two drug regimens were equally effective after 24 hours, but the sedative effects of diamorphine were evident more quickly than those of morphine. Both regimens significantly reduced plasma adrenaline concentrations over the first 24 hours of the infusions. No significant differences in mortality, ventilator days, chronic lung disease or intracranial lesions were noted.
  
  
  CONCLUSIONS
  Both drug regimens reduce the stress response to ventilation in preterm neonates. However, diamorphine's more rapid onset of sedation and morphine's hypotensive tendency suggest that diamorphine is preferable for the sedation of mechanically ventilated preterm neonates.
authors.affiliation: Academic Unit of Paediatrics and Child Health, University of Leeds, General Infirmary at Leeds.
authors.forename: C M
authors.initials: CM
authors.lastname: Wood
authors.forename: J A
authors.initials: JA
authors.lastname: Rushforth
authors.forename: R
authors.initials: R
authors.lastname: Hartley
authors.forename: H
authors.initials: H
authors.lastname: Dean
authors.forename: J
authors.initials: J
authors.lastname: Wild
authors.forename: M I
authors.initials: MI
authors.lastname: Levene
mesh_terms: D000758:Anesthesia; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004837:Epinephrine / Q000097:blood; D003932:Heroin; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood; D007385:Intermittent Positive-Pressure Ventilation; D009020:Morphine; D009022:Morphine Derivatives; D013312:Stress, Physiological / Q000517:prevention & control*
chemical_list: D009022:Morphine Derivatives; D003932:Heroin; D009020:Morphine; D004837:Epinephrine