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

Objective: To determine the safety of morphine for procedural pain management in nonintubated infants in the neonatal intensive care unit. Methods: Retrospective cohort study comparing nonintubated infants undergoing central line placement who received morphine during the procedure with a sex and age-matched group who did not receive morphine. The incidence of clinically significant respiratory depression and hypotension, defined as requiring intervention (ie, bag/mask ventilation, increased ventilatory support, and naloxone reversal for respiratory depression and saline volume expansion and inotropes for hypotension), were compared between groups using chi(2) test. Results: There were no differences (P > 0.05) between morphine (N = 43) and no morphine (N = 43) groups in gestational age [34.2 (4.6) vs. 34.6 (3.8) wk; P = 0.63], postnatal age [13.7 (22.6) vs. 12.3 (15) wk; P = 0.73], and weight [2.3 kg (0.9) for both groups]. Five (11.6%) morphine-treated infants experienced respiratory depression compared with none (0%) in the no morphine group (P = 0.02); removal of 2 overdosed infants in the morphine group reduced the incidence to 7.3%, which was not significantly different from 0% in the no morphine group (P = 0.07). There were no cases of hypotension. Conclusions: Morphine administration was associated with respiratory depression but not hypotension when administered to nonintubated infants undergoing central line placement. Morphine should be used with caution in this population.