Table 1.

Summary of output of key papers on neonatal analgosedation

Krekels et al.[13]

Morphine paediatric dosing algorithms corrected for pharmacokinetic differences alone yield effective doses that prevent overdosing for neonates younger than 10 days. Neonates and infants with a postnatal age beyond 10 days still required rescue medication. This warrants additional pharmacokinetic and pharmacodynamic studies to further optimize the dosing algorithm for these patients

Ceelie et al.[14]

Among infants – including neonates – undergoing major non-cardiac surgery, postoperative use of intermittent intravenous paracetamol compared with continuous morphine results in a lower cumulative morphine dose over 48 h (maintenance dose was reduced by 75%)

Anand et al.[31] and Simons et al.[32]

Pre-emptive morphine infusions do not reduce the frequency of severe intraventricular haemorrhage, periventricular leucomalacia or death in ventilated preterm neonates. Moreover, intermittent boluses of open-label morphine were associated with an increased rate of this composite outcome. The morphine doses used in this study decrease clinical signs of pain, but can cause significant adverse effects in ventilated preterm neonates. These adverse effects include prolonged respiratory support, hypotension and delayed attainment of full enteral feeding.[5–8]

de Graaf et al.[36]

Using the cohort initially described by Simons et al.,[32] this study demonstrated that continuous morphine infusion (10 μg/kg per hour) during the neonatal period does not harm general functioning at 8–9 years. There may even be a positive influence on executive functions at 8–9 years

Härma et al.[42]

Introduction of intravenous paracetamol was associated with a reduced need for morphine in a cohort of preterm neonates (<32 weeks gestational age)

Matic et al.[64]

Re-analysing earlier data sets ([32]), the need for rescue morphine in preterm neonates was associated with specific pharmacogenetic polymorphisms (μ-opioid receptor, cathechol O-methyltransferase gene variant)