title: Safety of morphine in nonintubated infants in the neonatal intensive care unit.
abstract: OBJECTIVE
  To determine the safety of morphine for procedural pain management in nonintubated infants in the neonatal intensive care unit.
  
  
  METHODS
  Retrospective cohort study comparing nonintubated infants undergoing central line placement who received morphine during the procedure with a sex and age-matched group who did not receive morphine. The incidence of clinically significant respiratory depression and hypotension, defined as requiring intervention (ie, bag/mask ventilation, increased ventilatory support, and naloxone reversal for respiratory depression and saline volume expansion and inotropes for hypotension), were compared between groups using chi test.
  
  
  RESULTS
  There were no differences (P>0.05) between morphine (N=43) and no morphine (N=43) groups in gestational age [34.2 (4.6) vs. 34.6 (3.8) wk; P=0.63], postnatal age [13.7 (22.6) vs. 12.3 (15) wk; P=0.73], and weight [2.3 kg (0.9) for both groups]. Five (11.6%) morphine-treated infants experienced respiratory depression compared with none (0%) in the no morphine group (P=0.02); removal of 2 overdosed infants in the morphine group reduced the incidence to 7.3%, which was not significantly different from 0% in the no morphine group (P=0.07). There were no cases of hypotension.
  
  
  CONCLUSIONS
  Morphine administration was associated with respiratory depression but not hypotension when administered to nonintubated infants undergoing central line placement. Morphine should be used with caution in this population.
authors.affiliation: Pharmacy Practice Division, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada. anna.taddio@utoronto.ca
authors.forename: Anna
authors.initials: A
authors.lastname: Taddio
authors.forename: Blondel
authors.initials: B
authors.lastname: Crosdale
authors.forename: Mary-Ellen
authors.initials: ME
authors.lastname: Hogan
authors.forename: Manal F
authors.initials: MF
authors.lastname: El Sayed
authors.forename: Kyong-Soon
authors.initials: KS
authors.lastname: Lee
authors.forename: Aideen M
authors.initials: AM
authors.lastname: Moore
authors.forename: Vibhuti
authors.initials: V
authors.lastname: Shah
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000453:epidemiology*; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007440:Intubation / Q000706:statistics & numerical data; D008297:Male; D009020:Morphine / Q000627:therapeutic use*; D009864:Ontario / Q000453:epidemiology; D010146:Pain / Q000453:epidemiology* / Q000517:prevention & control*; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine