Analgesic efficacy and safety of morphine in the Procedural Pain in Premature Infants (Poppi) study: randomised placebo-controlled trial

@article{Hartley2018AnalgesicEA,
  title={Analgesic efficacy and safety of morphine in the Procedural Pain in Premature Infants (Poppi) study: randomised placebo-controlled trial},
  author={Caroline Hartley and Fiona Moultrie and Amy Hoskin and Gabrielle Green and Vaneesha Monk and Jennifer L. Bell and Andy King and Miranda Buckle and Marianne van der Vaart and Deniz Gursul and Sezgi Goksan and Edmund Juszczak and Jane E. Norman and Richard Rogers and Chetan Kantibhai Patel and Eleri Adams and Rebeccah Slater},
  journal={Lancet (London, England)},
  year={2018},
  volume={392},
  pages={2595 - 2605}
}
View on Elsevier
thelancet.com
66 Citations
Highly Influential Citations
3
Background Citations
11
Methods Citations
4
Results Citations
2

Figures and Tables from this paper

66 Citations

Oral morphine analgesia for preventing pain during invasive procedures in non-ventilated premature infants in hospital: the Poppi RCT

The trial was stopped because of profound respiratory adverse effects of morphine without suggestion of analgesic efficacy, and oral morphine is not recommended for retinopathy of prematurity screening, and caution is strongly advised if this is being considering for other acute painful procedures in non-ventilated premature infants.

Multicentre, randomised controlled trial to investigate the effects of parental touch on relieving acute procedural pain in neonates (Petal)

Whether parental touch prior to a painful clinical procedure provides effective pain relief in neonates is determined to determine to determine whether parental tactile intervention is effective.

Clonidine as analgesia during retinopathy of prematurity screening in preterm infants (cloROP): protocol for a randomised controlled trial

The main aim of this trial is to investigate the analgesic effect of clonidine during ROP eye examinations, and changes in the galvanic skin response parameters within 30 s after starting the eye examination.

Intranasal fentanyl for pain management during screening for retinopathy of prematurity in preterm infants: a randomized controlled trial

Intranasal fentanyl significantly reduced the pain associated with retinal examination without increasing the risk of respiratory depression in preterm infants.

A universal right to pain relief: balancing the risks in a vulnerable patient population.

Is it time to replace morphine with methadone for the treatment of pain in the neonatal intensive care unit?

The pharmacokinetics of methadone and its metabolites after intravenous administration are investigated and large variations in clearance can be observed and might be the result of the variability in the studied neonatal populations (term vs preterm), and route of administration (intravenous vs oral).

A Critical Review on the Relevance of Paracetamol for Procedural Pain Management in Neonates

Based on the available evidence, paracetamol has opioid-sparing effects for major pain syndromes, is effective to treat minor to moderate pain syndromees, but fails for effective procedural pain management in neonates, which should stimulate the search for effective alternatives to prevent or treat pain.

Paracetamol and morphine for infant and neonatal pain; still a long way to go?

There is a clear call for integral research addressing the multimodality of pain in this population and further developing population pharmacokinetic models towards physiology-based models.

Preemptive Morphine During Therapeutic Hypothermia After Neonatal Encephalopathy: A Secondary Analysis.

Preemptive morphine sedation during TH does not offer any neuroprotective benefits and may be associated with increased hospital stay, and Optimal Sedation during induced hypothermia requires further evaluation in clinical trials.

Use of morphine before retinopathy of prematurity examinations

The Use of morphine before retinopathy of prematurity examinations the medications daily in the long run might be relatively low, and costeffectiveness analyses should address the question of whether daily use of aspirin and EPA would be less costly and more effective than regular surveillance colonoscopy.
...

References

SHOWING 1-10 OF 35 REFERENCES

A blinded randomised placebo-controlled trial investigating the efficacy of morphine analgesia for procedural pain in infants: Trial protocol

A blinded, placebo-controlled, parallel-group randomized, phase II, clinical trial will be undertaken to determine whether morphine sulphate administered orally prior to clinically-required retinopathy of prematurity screening and heel lancing provides effective analgesia.

Protocol 15PRT/5747: A blinded randomised placebo-controlled trial investigating the efficacy of morphine analgesia for procedural pain in infants

A blinded, placebo-controlled, parallel-group randomized, phase II, clinical trial will be undertaken to determine whether morphine sulphate administered orally prior to clinically-required retinopathy of prematurity screening and heel lancing provides effective analgesia.

Intravenous morphine and topical tetracaine for treatment of pain in [corrected] neonates undergoing central line placement.

In this study of ventilated neonates undergoing central line placement, morphine and tetracaine plus morphine provided superior analgesia to tetracane; however, morphine caused respiratory depression and tetacaine caused erythema.

Opioids for neonates receiving mechanical ventilation: a systematic review and meta-analysis

There is insufficient evidence to recommend routine use of opioids in mechanically ventilated newborns, and opioids should be used selectively, when indicated by clinical judgment and evaluation of pain indicators.

Improving the treatment of infant pain

Noxious stimulation evokes changes in activity across all levels of the infant nervous system, including reflex activity, altered brain activity and behaviour, and long-lasting changes in infant physiological stability, so well designed clinical trials are urgently required to improve analgesic provision in the infant population.

Safety of Morphine in Nonintubated Infants in the Neonatal Intensive Care Unit

Morphine administration was associated with respiratory depression but not hypotension when administered to nonintubated infants undergoing central line placement, and Morphine should be used with caution in this population.

Paracetamol and morphine for infant and neonatal pain; still a long way to go?

There is a clear call for integral research addressing the multimodality of pain in this population and further developing population pharmacokinetic models towards physiology-based models.

Consensus statement for the prevention and management of pain in the newborn.

  • K. Anand
  • Medicine
    Archives of pediatrics & adolescent medicine
  • 2001
Evidence-based guidelines for preventing or treating neonatal pain and its adverse consequences are developed and management of pain must be considered an important component of the health care provided to all neonates, regardless of their gestational age or severity of illness.

Efficacy of Sucrose to Reduce Pain in Premature Infants during Eye Examinations for Retinopathy of Prematurity

Oral sucrose may reduce the immediate pain response in premature infants undergoing eye examination for ROP, and for 3 of the 5 definitions of pain response, patients experienced significantly less pain at speculum insertion with sucrose than with placebo.

Eight Years Later, Are We Still Hurting Newborn Infants?

The mean number of painful procedures per NICU patient per day declined, and nonpharmacological pain- or stress-reducing strategies like NIDCAP and sucrose were fully embedded in the authors' pain management.