Abstract
Objectives: To study the gastrointestinal (GI) side-effects of morphine and the epidemiology of feeding and GI morbidity in preterm infants.
Background: Morphine slows gut motility, a key to the advancement of enteral feeds in preterm infants. Morphine may thus increase the risk of meconium inspissation and necrotising enterocolitis, and of complications related to parenteral feeding.
Methods: A post-hoc analysis was done of babies in the NEOPAIN trial, a double-blind. randomised controlled trial of pre-emptive morphine (M) or placebo (Pl) in ventilated preterm infants. A loading dose (100μg/kg of morphine) was followed by an infusion for up to 14 days at a gestation-dependent dose (10–30μg/kg/hr). Open-label morphine bolus (A) could be given if clinically indicated.
Subjects: There were 449 babies in each group. The gestations in weeks (median, range) were: 27, 23–32 for both groups. Birthweights in grams (median, range) were: M 984, 452-2030; Pl 985, 420-2440. The number of babies receiving A (no., %): M 201, 45; Pl 242, 55.
Results: Group M was later at starting feeds [S] (median, quartiles): M 5, 3–8; Pl 4, 2–7; P=0.02, and attaining full feeds [F]: M 20, 13–29; Pl 17, 12–26; P=0.003. There was a weak correlation between total dose of morphine (TDM) and these outcomes: For S rsq.=0.12, P<0.001; for F rsq.=0.07, P<0.001. There was no relationship between morphine and GI complications (necrotising enterocolitis or intestinal obstruction): M 9/449, Pl 8/449; Chi sq. P=0.81. On multivariate analysis, S was independently associated with centre (P=0.03), the use of an umbilical venous catheter (P<0.001) and TDM (P<0.001), and F with birthweight (P=0.005), hypotension (P=0.04), Neonatal Medical Index (a morbidity score, P=0.001), and TDM (P=0.001).
Conclusions: Morphine delays the attainment of full enteral feeds, but does not increase GI complications. Ages of starting and full feeds are associated with morphine dose, but are influenced by several other factors.
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Menon, G., Boyle, E., McIntosh, N. et al. 238 Gastrointestinal Outcomes in a Randomised Controlled Trial of Pre-Emptive Morphine Analgesia in Preterm Infants. Pediatr Res 58, 395 (2005). https://doi.org/10.1203/00006450-200508000-00267
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DOI: https://doi.org/10.1203/00006450-200508000-00267