• Catherine S Birken, Amina Khambalia, Annie Dupuis, Aimee Pastor, Michelle Lee, Karen Padavattan, Magda Mekky, Isaac Odame, and Patricia C Parkin.
• Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. catherine.birken@sickkids.ca
• Hosp Pediatr. 2013 Apr 1; 3 (2): 149-55.

ObjectiveTo 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.MethodsHealth 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.ResultsThere 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).ConclusionsWe recommend close observation for ACS in hospitalized patients with SCD who are receiving morphine.

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