Summary of findings 3. Morphine compared to paracetamol for postoperative pain in neonates.
Morphine compared to paracetamol for postoperative pain in neonates | ||||||
Patient or population: postoperative pain in preterm and term infants Setting: neonatal intensive care unit Intervention: morphine Comparison: paracetamol | ||||||
Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
Risk with paracetamol | Risk with morphine | |||||
Pain assessed with COMFORT scale | The mean pain assessed with COMFORT scale was 0. | MD 0.10 higher (0.85 lower to 1.05 higher) | ‐ | 71 (1 RCT) | ⊕⊝⊝⊝ Very low1 | The evidence is very uncertain about the effect of morphine on this outcome compared to paracetamol. |
Major neurodevelopmental disability in children aged 18 to 24 months | ‐ | ‐ | ‐ | ‐ | This outcome was not reported. | |
Major neurodevelopmental disability in children aged three to five years | ‐ | ‐ | ‐ | ‐ | This outcome was not reported. | |
Cognitive and educational outcomes in children more than five years old | ‐ | ‐ | ‐ | ‐ | This outcome was not reported. | |
All‐cause mortality during initial hospitalization | ‐ | ‐ | ‐ | ‐ | This outcome was not reported. | |
Severe retinopathy of prematurity (defined as stage 3 or greater) | ‐ | ‐ | ‐ | ‐ | This outcome was not reported. | |
Severe intraventricular hemorrhage (grade 3 or greater) on cranial ultrasound, as per Papile classification | ‐ | ‐ | ‐ | ‐ | This outcome was not reported. | |
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference; OR: odds ratio; RCT: randomized controlled trial; RR: risk ratio; | ||||||
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. |
1Downgraded one level for study limitations: unclear selection and reporting risk of bias; downgraded two levels for imprecision: one small trial with wide confidence of interval