Morphine-related apnoea in CPAP-treated preterm neonates.
BACKGROUND
Morphine can be used to treat pain in preterm neonates with CPAP because of its analgetic potency; however, it is known to induce apnoea.


OBJECTIVE
To evaluate this risk of apnoea.


METHODS
We retrospectively analysed 91 preterm neonates with CPAP who received morphine intravenously. The incidence of apnoea 4 h before and after morphine administration was compared. The data were analysed for three dosage groups (<0.01, 0.01-0.03 and 0.03 mg/kg) and according to the incidence of apnoea before morphine application.


RESULTS
In the whole group (gestational age 29.1+/-2.9 wk, morphine dosage 0.017+/-0.01 mg/kg) we did not find differences in apnoea before and after morphine (0.9+/-1.8 vs 1.1+/-1.8 apnoea). The only significant increase in apnoea was seen in the subgroup of patients receiving > 0.03 mg/kg (0.3+/-0.67 vs 1.5+/-2.5 apnoea). Interestingly, we found a significantly delayed increase in apnoea in the fourth hour.


CONCLUSIONS
Morphine in preterm infants with CPAP is not widely accepted practice until further randomized studies evaluate efficacy and safety. Morphine in a low dosage (<or=0.03 mg/kg) did not significantly increase the apnoea rate in CPAP-treated preterm infants. For clinical work, it is very important to note that morphine-related apnoea may appear with a delay of approximately 4 h.
Enders
Jan
J
Children's Hospital, Department of Neonatology, University Hospital, Leipzig, Germany.
Gebauer
Corinna
C
Pulzer
Ferdinand
F
Robel-Tillig
Eva
E
Knüpfer
Matthias
M
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D001049:Apnea / Q000139:chemically induced*; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000139:chemically induced*; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D000701:Analgesics, Opioid; D009020:Morphine