• Arch. Dis. Child. Fetal Neonatal Ed. · Sep 2008

    Randomized Controlled Trial Multicenter Study

    Morphine analgesia and gastrointestinal morbidity in preterm infants: secondary results from the NEOPAIN trial.

    • G Menon, E M Boyle, L L Bergqvist, N McIntosh, B A Barton, and K J S Anand.
    • Department of Neonatology, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, Scotland, UK. gopi.menon@luht.scot.nhs.uk
    • Arch. Dis. Child. Fetal Neonatal Ed. 2008 Sep 1; 93 (5): F362-7.

    ObjectiveTo investigate the influence of morphine therapy and other factors on the attainment of full enteral feeds and on acquired gastrointestinal pathology in preterm infants.DesignSecondary data analysis from a randomised, placebo controlled trial.Setting16 neonatal intensive care units in USA, Sweden, France and UK.Patients898 infants (treatment group 449, control 449). Gestation (median (range)): 27 (23-32) weeks; birth weight (median (range)): 985 (420-2440) g.InterventionsMorphine (M) or placebo (Pl) given pre-emptively by intravenous loading dose (100 microg/kg of morphine) and infusion (10-30 microg/kg/h depending on gestation) while infants were ventilated, for up to 14 days. "Open-label" morphine (A) could be given if clinically indicated.Main Outcome MeasuresAge at full enteral feeds and major acquired gastrointestinal pathology.ResultsThe group randomised to morphine was later in attaining full feeds (median days (quartiles): M 20 (13-29), Pl 17 (12-26); p = 0.003), and in starting feeds (median days (quartiles): M 5 (3-8), Pl 4 (2-7)). In a linear regression model, age at full feeds was independently associated with birth weight, a score of neonatal morbidities, neonatal dexamethasone use and cumulative morphine dose. There was no relationship between morphine use and acquired gastrointestinal pathology (M 9/449, Pl 8/449; chi2 p = 0.81).ConclusionsMorphine delays the attainment of full enteral feeds, partly by delaying the start of feeding, but does not discernibly increase gastrointestinal complications. The attainment of full feeds is influenced by morphine dose, but other factors seem to be important, including birth weight and neonatal morbidity.

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