A sick premature baby who requires
intensive care will undergo many uncomfortable procedures. It is now accepted that such babies perceive
pain 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 randomised, double-blind, placebo-controlled trial. 41 mechanically ventilated babies who had been treated with
surfactant (
Curosurf) for
hyaline membrane disease were randomly assigned
morphine in 5%
dextrose (100 micrograms/kg per h for 2 h followed by 25 micrograms/kg per h continuous infusion) or 5%
dextrose (placebo). Plasma
catecholamine concentrations were measured 1 h after the first dose of
surfactant and 24 h later. Blood pressure was measured at study entry and after 6 h. The
morphine and placebo 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 (median change 0.2 [-0.6 to 0.6] nmol/L, p = 0.79). There was a non-significant reduction in
noradrenaline concentration in the
morphine group. Blood pressure showed a slight but non-significant fall (median -4 mm Hg) in
morphine-treated babies. The incidence of intraventricular haemorrhage,
patent ductus arteriosus, and
pneumothorax, the number of
ventilator days, and the numbers of deaths did not differ significantly between the groups.
Morphine, in the dose regimen we used, is safe and effective in reducing
adrenaline concentrations in preterm ventilated babies.