The effects of morphine on serum cortisol and catecholamine in premature infants receiving mechanical ventilation / 中国新生儿科杂志

ABSTRACT

Objective To study the effects of morphine on serum concentrations of cortisol (COR), adrenaline (ADR), noradrenaline (NAD) and dopamine (DOP) in premature infants requiring mechanical ventilation (MV).Method From January to November, 2017, premature infants (gestational age 28～36 weeks and body weight1 000～2 499 g) admitted to neonatal department of our hospital and received mechanical ventilation were prospectively studied.The participants were randomly assigned into morphine group and control group.Modified neonatal pain assessment scale ( NIPS ) and Ramsay scores were calculated at the beginning of MV (before the administration of morphine ) and at different time points after MV (2 h, 12 h, 24 h and 48 h after the administration of morphine ).Serum concentrations of COR , ADR, NAD and DOP were also measured at the beginning of MV and 24 h after MV/morphine.The scores and concentrations were compared between the two groups.Result A total of 60 infants were included, with 30 infants in each group.The modified NIPS and Ramsay scores and serum concentrations at the beginning of MV were similar between the two groups ( P＞0.05).The modified NIPS and Ramsay scores at 2 h, 12 h, 24 h and 48 h after the initiation of MV were significantly lower in the morphine group comparing with the control group[2 h (0.8 ±0.5) vs.(2.9 ±0.7), (0.9 ±0.6) vs.(2.3 ±0.6); 12 h (1.1 ±0.6) vs.(2.8 ±0.8), (1.3 ±0.7) vs.(2.3 ±0.8); 24 h (1.4 ±0.8) vs.(3.0 ±0.7), (1.6 ±0.6) vs. (2.4 ±0.8); 48 h (1.3 ±0.7) vs.(2.7 ±0.9), (1.7 ±0.7) vs.(2.5 ±0.8)].Furthermore, serum concentrations of COR, ADR, NAD and DOP at 24 h after MV were also significantly lower in the morphine group [COR (165.4 ±25.0) nmol/L vs.( 319.8 ±71.2) nmol/L, ADR ( 30.3 ±4.5) ng/L vs. (45.4 ±4.3) ng/L,NAD (138.0 ±16.5) ng/L vs.(230.5 ±26.1) ng/L, DOP (43.6 ±7.2) ng/L vs.(86.3 ±10.0) ng/L, P＜0.05].Conclusion Morphine is associated with lower serum concentration of catecholamine and lower NIPS scores during MV in premature infants.