Longterm morphine administration in newborn

Background: Morphine is a standard postoperative pain treatment in newborns. Continuous infusion or intermittent intravenous boluses are the common forms of usage. To prevent complications of long term intravenous lines and provide a more comfortable situation morphine is administered subcutaneously.

Objective: Cohort study which analyzed the data of newborn patients who were treated postoperatively with morphine via a subcutaneous catheter.

Methods: 20 newborn patients were analyzed. After a certain time of continuous morphine infusion patients received morphine boluses via a special subcutaneous catheter (Figure 1: Insuflon®; Unomedical A/S, Lynge, Denmark). Morphine dosages, duration of treatment and side effects were analyzed.

Results: Operations were performed at the median age of 38 5/7 weeks (range 32 1/7–49 5/7 w). Median treatment duration was 7.5 days (range 2–17d). Only in one case a harmless local side effect (bleeding) was noted. 3/20 patients reacted with pain to the first injection. None of the patients showed hypotension or apnea. Median dose at the first day was 0.1mg/kg 6 times per day. This was reduced to a minimum of 0.045mg/kg (range 0.005–0.3mg). The application interval was stretched from 4 to a median of 8 hours (range: 4–24h). Withdrawal symptoms were seen in 3/20 patients.

Conclusions: The subcutaneous application of morphine in newborn via this catheter is an valuable alternative to intravenous treatment of postoperative pain in neonates. Pain release is good and side effects are harmless.