title: Morphine is associated with acute chest syndrome in children hospitalized with sickle cell disease.
abstract: OBJECTIVE
  To determine if intravenous morphine is associated with acute chest syndrome (ACS) in children with homozygous for hemoglobin S sickle cell disease (SCD) hospitalized with acute pain.
  
  
  METHODS
  Health records of patients with homozygous for hemoglobin S SCD aged 2 to 18 years hospitalized with acute pain were reviewed. Patients developed ACS at least 12 hours after emergency department triage; controls did not develop ACS. Survival analyses were performed.
  
  
  RESULTS
  There were 38 cases and 45 randomly selected controls. The mean hourly dose of morphine 1, 2, and 3 hours before ACS and cumulative mean morphine dose up to 5 hours before ACS were significantly associated with ACS (P < .05). Adjusted analysis showed that 1 hour before ACS, the mean morphine dose was significantly higher in cases (40 microg/kg) compared with controls (34 microg/kg), and the risk of ACS increased by 23% for each additional 10 microg/kg of morphine received (P = .02).
  
  
  CONCLUSIONS
  We recommend close observation for ACS in hospitalized patients with SCD who are receiving morphine.
authors: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. catherine.birken@sickkids.ca
authors: Catherine S
authors: CS
authors: Birken
authors: Amina
authors: A
authors: Khambalia
authors: Annie
authors: A
authors: Dupuis
authors: Aimee
authors: A
authors: Pastor
authors: Michelle
authors: M
authors: Lee
authors: Karen
authors: K
authors: Padavattan
authors: Magda
authors: M
authors: Mekky
authors: Isaac
authors: I
authors: Odame
authors: Patricia C
authors: PC
authors: Parkin
mesh_terms: D056586:Acute Chest Syndrome / Q000150:complications*; D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000755:Anemia, Sickle Cell / Q000150:complications*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009020:Morphine / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine