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Baby in incubator

Administering oral morphine to non-ventilated premature infants is not recommended for the provision of pain relief during retinopathy of prematurity screening – an eye exam that helps prevent blindness in premature babies, according to a study published in The Lancet.

Infant pain has immediate and long-term effects but is under-treated because of a paucity of evidence regarding analgesics. Morphine is routinely used to relieve pain in ventilated babies and is effective at relieving pain in children and adults. However, it was previously unclear whether morphine provided safe and effective pain relief during medically essential procedures in non-ventilated babies.

Researchers from the Department of Paediatrics and the National Perinatal Epidemiology Unit (NPEU), part of the Nuffield Department of Population Health at the University of Oxford, worked with local collaborators to assess the analgesic efficacy and safety of oral morphine used during essential procedures that are thought to cause pain in premature infants.

Associate Professor Ed Juszczak, Director of the NPEU Clinical Trials Unit, said: ‘We investigated whether giving morphine to non-ventilated premature babies before their routine blood tests and eye examinations would reduce their pain and make them more stable. We found that administering morphine to non-ventilated babies has the potential for harm, and evidence of pain relief was not demonstrated in this study.’ 

The results of the Procedural Pain in Premature Infants (Poppi) trial show that administration of oral morphine to non-ventilated premature infants prior to examination for retinopathy of prematurity has the potential for harm without suggestion of analgesic efficacy. 

Difficulties in measuring infant pain are widely recognised. The Poppi researchers used innovative methods to measure the efficacy and safety of morphine in non-ventilated infants that set new standards for the conduct of clinical trials of analgesics in infants.

Professor Rebeccah Slater, Head of Paediatric Neuroimaging in the Department of Paediatrics, said: The project has bought together people from many disciplines who want to improve the treatment of pain in prematurely-born infants. We are very excited about the next phase of our work where we will use the methodology developed in the Poppi trial to test the analgesic efficacy and safety of other pharmacological interventions.’

For full details of the methods used and the findings, please read the article in The Lancet or view this animation