Arch. Dis. Child

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH REGISTER


[Advanced]
The most recent version of this article was published on 1 January 2006

Arch. Dis. Child. Fetal Neonatal Ed.. Published Online First: 30 August 2005. doi:10.1136/adc.2004.069831
Copyright © 2005 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health
This Article
Right arrow Full Text (Rapid PDF)
Right arrow All Versions of this Article:
adc.2004.069831v1
91/1/F46    most recent
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this link to a friend
Right arrow Similar articles in ADC Online
Right arrow Similar articles in PubMed
Right arrow Add article to my folders
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Simons, S. H P
Right arrow Articles by Tibboel, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Simons, S. H P
Right arrow Articles by Tibboel, D.

Original articles

Morphine in ventilated neonates: Its effects on arterial blood pressure

Sinno H P Simons 1, Daniëlla W E Roofthooft 1, Monique van Dijk 1, Richard A van Lingen 2, Hugo J Duivenvoorden 3, John N van den Anker 1 and Dick Tibboel 1*

1 Erasmus MC - Sophia, Netherlands
2 Isala Clinics, Netherlands
3 Erasmus MC, Netherlands

* To whom correspondence should be addressed. E-mail: j.illsley{at}erasmusmc.nl.

Accepted 27 July 2005


*   Abstract

Objective:To study the effects of continuous morphine infusion on arterial blood pressure in ventilated neonates.

Design:Blinded randomised placebo-controlled trial.

Setting:Level III Neonatal Intensive Care Unit in two centres.

Patients:144 ventilated neonates (Inclusion criteria: postnatal age < 3 days, ventilation < 8 hours, indwelling arterial line. Exclusion criteria: severe asphyxia, severe IVH, major congenital anomalies, neuromuscular blockers).

Intervention:Arterial blood pressure was measured before the start and during the first 48 hours of masked medication infusion (morphine/placebo; 100 µg/kg + 10 µg/kg/h).

Outcome measures:arterial blood pressure and blood pressure variability.

Results:There were no significant differences in overall MAP (mean arterial blood pressures) between the morphine group (median 36 mmHg; IQR 6) and the placebo group (median 38 mmHg; IQR 6)(p=0.11). Although significantly more morphine treated patients (70%) showed hypotension compared to the placebo group (47%) (p=0.004), the use of volume expanders and vasopressor drugs was not significantly different (morphine group: 44 %; placebo group: 48 %; p=0.87) indicating the limited clinical significance of this side effect. Blood pressure variability was not influenced by routine morphine analgesia (p=0.81) and additional morphine (p=0.80). Patients with and without intraventricular haemorrhage showed no differences in blood pressures (Mann Whitney U-tests:1953; p=0.14) and incidence of hypotension (÷2 test: 1.16; df: 1; p=0.28).

Conclusions:Overall arterial blood pressures, use of inotropic therapy and blood pressure variability were not influenced by morphine infusion. Therefore, the clinical impact of hypotension as a side effect of low dose morphine treatment in neonates is negligible.

Keywords: randomised controlled trial, opioids, hypotension, blood pressure variability






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH REGISTER
ARCH DIS CHILD FETAL NEONATAL ED ED PRACTICE
Terms and conditions relating to subscriptions purchased online  ¦  Website terms and conditions  ¦  Privacy policy
Copyright © 2005 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health