Analgosedation with low-dose morphine for preterm infants with CPAP: risks and benefits.
BACKGROUND
CPAP is widely used in preterm infants on NICUs but it poses a stressful stimulus to the patient, sometimes requiring the use of analgosedative drugs.


OBJECTIVE
The aim of this study is to evaluate the risks and benefits associated with the use of low-dose morphine in preterm infants with CPAP, especially apnea.


METHODS
Sixty-four CPAP-treated preterm infants, who received a low single dose of morphine (recommended 0.01 mg/kg), were included in this prospective study. Observation-time was 4 h prior to injection, directly before injecting, until 15 min and 15-30 min, 30 min-1 h, 1-2 h, 2-3 h, 3-4 h, 4-5 h and 5-6 h after injection. For all observation periods incidence of apnea, heart rate, respiratory rate and a score for analgesia and for sedation were recorded.


RESULTS
Sixty-four preterm infants (29.6+/-3.3 weeks gestational age (GA), birth weight 1401+/-735 g) received 0.025+/-0.012 mg/kg morphine i.v. on the day 10-13 of life. The decrease in heart and respiratory rate, scores for analgesia and sedation were significant. The overall incidence of apnea did not increase compared to the 4 h pre-morphine period. Six patients (9.3%) experienced considerable delayed apnea. This group was significantly younger in GA (p<0.001) and lighter in birth weight (p=0.002).


CONCLUSIONS
Morphine in dosage less than half of recommended dosage has a high analgetic and sedative potential. The danger of delayed severe apnea has to be taken into consideration in the clinical situation, especially in patients<28 weeks.
Enders
J
J
Children's Hospital, Department of Neonatology, University Hospital, Leipzig, Germany.
Gebauer
C
C
Pulzer
F
F
Robel-Tillig
E
E
Knüpfer
M
M
D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D001049:Apnea / Q000139:chemically induced; D016292:Procedural Sedation; D045422:Continuous Positive Airway Pressure; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D007363:Intensive Care Units, Neonatal; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D012119:Respiration / Q000187:drug effects; D012120:Respiration Disorders / Q000628:therapy; D012307:Risk Factors
D000701:Analgesics, Opioid; D009020:Morphine