Duong Phoï, Tauzin Manon, Decobert Fabrice, Marchand Laetitia, Caeymaex Laurence, Durrmeyer Xavier
Neonatal Intensive Care Unit CHI Créteil Créteil France.
CRESS INSERM 1153 INRA Université de Paris Paris France.
Paediatr Neonatal Pain. 2020 Jan 3;1(2):45-52. doi: 10.1002/pne2.12011. eCollection 2019 Dec.
Continuous intravenous (IV) morphine is commonly used in ventilated neonates. Oral route is theoretically feasible but data on oral morphine in ventilated premature infants are lacking.
To assess the efficacy, efficiency, and tolerability of a continuous intravenous to oral morphine switch protocol.
Retrospective study.
Single level III center's neonatal intensive care unit.
Ventilated premature infants hospitalized in the NICU in 2016 and 2017, receiving continuous IV morphine with an expected ventilation course of at least 72 more hours. We excluded patients treated for withdrawal syndrome or palliative care.
Continuous IV to oral morphine switch with the same initial cumulated daily dose.
Pain scores (ComfortNeo scale) and morphine doses were analyzed over time using Friedman's test in the 24 hours preceding and the 48 hours following the oral switch. Adverse effects attributable to opioids were collected.
Seventeen infants were included with a median [IQR] gestational age at birth of 25.9 [24.6-26.9] weeks and a median postnatal age at oral switch of 30 [22-36] days. One patient's intravenous treatment had to be resumed because of a high ComfortNeo score. All others remained on oral morphine. No significant change over time was observed for ComfortNeo scores ( = .15). Median [IQR] doses were 13.5 [10-20] µg/kg/h in the IV period and significantly increased to 15 [10-25] µg/kg/h in the oral period ( = .009). No short-term respiratory, digestive, or urinary adverse event was observed. After a median [IQR] duration of 13 [4-20] days of oral morphine treatment, 11 (65%) patients showed signs of withdrawal. Upon hospital discharge, 16 infants (94%) had bronchopulmonary dysplasia and none had severe cerebral abnormality on brain imaging.
Oral morphine might be useful in ventilated neonates in the NICU but deserves further studies and additional safety assessment.
持续静脉注射吗啡常用于机械通气的新生儿。口服途径理论上可行，但缺乏关于机械通气早产儿口服吗啡的数据。
评估持续静脉注射改为口服吗啡方案的疗效、有效性和耐受性。
回顾性研究。
单一的三级中心新生儿重症监护病房。
2016年和2017年在新生儿重症监护病房住院的机械通气早产儿，接受持续静脉注射吗啡，预期通气时间至少再延长72小时以上。我们排除了接受戒断综合征治疗或姑息治疗的患者。
以相同的初始累积日剂量从持续静脉注射改为口服吗啡。
在口服转换前24小时和转换后48小时内，使用弗里德曼检验分析疼痛评分（ComfortNeo量表）和吗啡剂量随时间的变化。收集阿片类药物引起的不良反应。
纳入17例婴儿，出生时胎龄中位数[四分位间距]为25.9[24.6 - 26.9]周，口服转换时出生后年龄中位数为30[22 - 36]天。1例患者因ComfortNeo评分高而不得不恢复静脉治疗。其他所有患者继续口服吗啡。未观察到ComfortNeo评分随时间的显著变化（P = 0.15）。静脉注射期间吗啡剂量中位数[四分位间距]为13.5[10 - 20]μg/kg/h，口服期间显著增加至15[10 - 25]μg/kg/h（P = 0.009）。未观察到短期呼吸、消化或泌尿系统不良事件。口服吗啡治疗中位数[四分位间距]持续13[4 - 20]天后，11例（65%）患者出现戒断症状。出院时，16例婴儿（94%）患有支气管肺发育不良，脑成像检查均未发现严重脑异常。
口服吗啡可能对新生儿重症监护病房中机械通气的新生儿有用，但值得进一步研究和进行额外的安全性评估。
