Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial

Anand, K.J.S.; Hall, Richard; Desai, Nirmala S.; Shephard, Barbara; Bergqvist, Lena; Young, Thomas E.; Boyle, Elaine M.; Carbajal, Ricardo; Bhutani, Vinod K.; Moore, Mary B.; Kronsberg, Shari S.; Barton, Bruce

doi:10.1016/s0140-6736(04)16251-x

Cited by 516 publications

(435 citation statements)

References 48 publications

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“…To bridge the gap between knowledge and practice, national and international collaborations formed to develop research-based best practice clinical guidelines to inform effective neonatal pain management (Anand & International Evidence-Based Group for Neonatal Pain 2001;Anand et al 2004;Carbajal et al 2008;Gradin & Eriksson 2010). Designed to support decisionmaking in patient care, these guidelines enable neonatal staff to advocate for and provide scientifically approved interventions to assess, diagnose, prevent, alleviate and treat neonatal pain.…”

Section: Literature Reviewmentioning

confidence: 99%

Knowledge, attitudes and practices of neonatal staff concerning neonatal pain management

Khoza

Tjale

2014

curationis

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Background: Neonatal pain management has received increasing attention over the past four decades. Research into the effects of neonatal pain emphasises the professional, ethical and moral obligations of staff to manage pain for positive patient outcomes. However, evaluation studies continuously report evidence of inadequate neonate pain management and a gap between theory and practice.Objective: This study reviewed current practice in neonatal pain management to describe the knowledge, attitudes and practices of nurses and doctors regarding pain management for neonates in two academic hospitals.Method: A non-experimental, prospective quantitative survey, the modified Infant Pain Questionnaire, was used to collect data from 150 nurses and doctors working in the neonatal wards of two academic hospitals in central Gauteng.Results: The response rate was 35.33% (n = 53), most respondents being professional nurses (88.68%; n = 47) working in neonatal intensive care units (80.77%; n = 42); 24 (45.28%) had less than 5 years’ and 29 respondents 6 or more years’ working experience in neonatal care. A review of pain management in the study setting indicated a preference for pharmacological interventions to relieve moderate to severe pain. An association (p < 0.05) was found between pain ratings on 5 procedures and frequency of administration of pharmacological pain management. Two-thirds of respondents (64%) reported that there were no pain management guidelines in the neonatal wards in which they worked.Conclusion: The interventions to manage moderate neonatal pain are in line with international guidelines. However, neonatal pain management may not occur systematically based on prior assessment of neonatal pain, choice of most appropriate intervention and evaluation. This study recommends implementation of a guideline to standardise practice and ensure consistent and adequate pain management in neonates.

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Section: Literature Reviewmentioning

confidence: 99%

Knowledge, attitudes and practices of neonatal staff concerning neonatal pain management

Khoza

Tjale

2014

curationis

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“…32,33 The data in this study reveal a new, previously undescribed association between IVH and the lack of response to dopamine, rather the measured blood pressure at the time of treatment initiation. While no particular indicators for treatment success could be identified, a more extensive delivery room resuscitation (as indirectly indicated by lower Apgar scores at 5 minutes) is associated with an increased likelihood of treatment failure.…”

Section: Discussionmentioning

confidence: 69%

Erratum: Response to dopamine in prematurity: a biomarker for brain injury?

Vesoulis¹,

Ters²,

Foster³

et al. 2016

J Perinatol

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Objective-Identify factors associated with responsiveness to dopamine therapy for hypotension and the relationship to brain injury in a cohort of preterm infants.Study Design-The pharmacy database at St. Louis Children's Hospital was retrospectively queried to identify infants who (a) were born < 28 weeks gestation between 2012-14, (b) received dopamine, and (c) had blood pressure measurements from an umbilical arterial catheter. A control group was constructed from contemporaneous infants who did not receive dopamine. Mean arterial blood pressure (MABP) at baseline, 1h and 3h after initiating dopamine were obtained for each dopamine-exposed infant. MABP measurements at matched time points were obtained in the control group.Results-Sixty-nine dopamine-treated and forty-five control infants were included. Mean ΔMABP at 3h was 4.5±6.3 mm of Hg for treated infants versus 1±2.9 for the control. Median dopamine starting dose was 2.5 µg/kg/min. Dopamine-treated infants were less mature and lower birth weight while also more likely to be intubated at 72h, diagnosed with intraventricular hemorrhage (IVH), and to die. Failure to respond to dopamine was associated with greater likelihood of developing IVH (OR 5.8, 95% CI 1.1-42.3), while a strong response (ΔMABP >10 mmHg) was associated with a reduction in risk of IVH (OR 0.1, 95% CI 0.01-0.8).Conclusions-Low-moderate dose dopamine administration results in modest blood pressure improvements. A lack of response to dopamine is associated with a greater risk of IVH while a strong response is associated with a decreased risk. Further research into underlying mechanisms and management strategies is needed. Keywords blood pressure; intraventricular hemorrhage; hypotension Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use

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“…Hypotension has also been associated with morphine infusions in previous trials, 11,17 where the incidence was greater than 25% among preterm infants in the first 24 h of morphine infusion and in those who were hypotensive before morphine therapy. Our findings here may represent a more mature group of neonates, as in contrast to Anand's study all our study infants were greater than 36 weeks gestation.…”

Section: Discussionmentioning

confidence: 93%

Safety profile of morphine following surgery in neonates

et al. 2007

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Objective: To determine the effect of morphine on duration of mechanical ventilation, apnoea and hypotension among full-term neonates who underwent thoracic or abdominal surgery in a level III neonatal intensive care unit.Method: Medical records of 82 infants were reviewed retrospectively and data including patient demographics, clinical diagnosis, type of surgery, postoperative opioid administration, duration of mechanical ventilation, hypotension, apnoea and pain scores (premature infant pain profile (PIPP) score) were collected.Result: Sixty-two neonates (76%) received morphine following surgery as a continuous intravenous infusion during the postoperative period. Linear regression analysis showed that morphine dosage and duration were significantly associated with the duration of mechanical ventilation. An increase in morphine infusion rate by 10 mg kg À1 h À1 was associated with an increase in the duration of mechanical ventilation by 24 h (P<0.0001) and an increase in morphine duration of 1 hour was associated with a longer duration of mechanical ventilation by 38 min (P<0.0001). Logistic regression analysis showed no association between morphine infusion rate or duration and hypotension. Apnoea was not associated with morphine dosage or duration of infusion in neonates receiving morphine following extubation. Score on the PIPP correlated significantly with morphine infusion rate across time (r ¼ 0.47, P<0.01). Conclusion:Postoperative morphine dose and duration may prolong the duration of mechanical ventilation but there are no significant dosedependent effects on other parameters including apnoea or hypotension following extubation in term neonates. More research is needed to determine the safety profile of morphine for management of pain in nonventilated neonates.

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Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial

Cited by 516 publications

References 48 publications

Knowledge, attitudes and practices of neonatal staff concerning neonatal pain management

Knowledge, attitudes and practices of neonatal staff concerning neonatal pain management

Erratum: Response to dopamine in prematurity: a biomarker for brain injury?

Safety profile of morphine following surgery in neonates

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