RANDOMIZED DOUBLE-BLIND CONTROLLED TRIAL OF EFFECT OF MORPHINE ON CATECHOLAMINE CONCENTRATIONS IN VENTILATED PRETERM BABIES

A sick premature baby who requires intensive care will undergo many un comfortable procedures. It is now accepted that such babies perceive p ain and need adequate analgesia, but little is known about the effects of sedation in these patients. We investigated the use of morphine to provide analgesia and sedation for ventilated preterm babies in a ran domised, double-blind, placebo-controlled trial. 41 mechanically venti lated babies who had been treated with surfactant (Curosurf) for hyali ne membrane disease were randomly assigned morphine in 5% dextrose (10 0 mug/kg per h for 2 h followed by 25 mug/kg per h continuous infusion ) or 5% dextrose (placebo). Plasma catecholamine concentrations were m easured 1 h after the first dose of surfactant and 24 h later. Blood p ressure was measured at study entry and after 6 h. The morphine and pl acebo groups showed no differences in method of delivery, Apgar scores , birthweight, gestation, or catecholamine concentrations at baseline. Morphine-treated babies showed a significant reduction in adrenaline concentrations during the first 24 h (median change -0.4 95% CI -1.1 to -0.3! nmol/L, p<0.001), which was not seen in the placebo group (me dian change 0.2 -0.6 to 0.6! nmol/L, p=0.79). There was a non-signifi cant reduction in noradrenaline concentration in the morphine group. B lood pressure showed a slight but non-significant fall (median -4 mm H g) in morphine-treated babies. The incidence of intraventricular haemo rrhage, patent ductus arteriosus, and pneumothorax, the number of vent ilator days, and the numbers of deaths did not differ significantly be tween the groups. Morphine, in the dose regimen we used, is safe and e ffective in reducing adrenaline concentrations in preterm ventilated b abies.