Randomised double blind trial of morphine versus diamorphine for sedation of preterm neonates
Academic Unit
of Paediatrics and Child Health, University of
Leeds, The General Infirmary at Leeds
Correspondence to: Dr CM Wood Department of Paediatrics, Hull Maternity Hospital, Hedon Road, Hull HU9 5LX.
Accepted 14 January 1998
AIMS
To compare the
safety and effectiveness of morphine and diamorphine for the sedation
of ventilated preterm neonates in a double blind, randomised trial.
METHODSEighty eight
babies were allocated to receive either morphine (n = 44) or
diamorphine (n = 44) by bolus infusion (200 or 120 mcg/kg,
respectively, over two hours), followed by maintenance infusion (25 or
15 mcg/kg/h, respectively) during the initial phase of their
respiratory disease. Serial monitoring of physiological, behavioural,
and biochemical variables over the first 24 hours of the infusions was
performed. Longer term outcomes were also monitored.
RESULTSMorphine,
but not diamorphine, was associated with a mean (SEM) decrease in mean
arterial blood pressure of 2.2 (1.0) mm Hg (p = 0.05) over the initial
loading infusion. Physiological (blood pressure variability) and
behavioural measures of sedation (clinical assessment and sedation
scoring) indicated that the two drug regimens were equally effective
after 24 hours, but the sedative effects of diamorphine were evident
more quickly than those of morphine. Both regimens significantly
reduced plasma adrenaline concentrations over the first 24 hours of the
infusions. No significant differences in mortality, ventilator days,
chronic lung disease or intracranial lesions were noted.
CONCLUSIONSBoth
drug regimens reduce the stress response to ventilation in preterm
neonates. However, diamorphine's more rapid onset of sedation and
morphine's hypotensive tendency suggest that diamorphine is preferable
for the sedation of mechanically ventilated preterm neonates.
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