Morphine OK For Babies?

Premature infants on ventilators are getting a tiny dose of morphine at
the University of Kentucky Children's Hospital.

As part of a study funded by the National Institutes of Health, a dozen hospitals nationwide will examine whether pain medication can improve the medical results of their tiniest patients.

Ventilators are used for premature infants whose lungs are not sufficiently developed to allow them to breathe on their own. Though adult patients on ventilators are routinely given pain medication, such treatment generally has not been given to premature infants.

In the past, doctors believed that the brains of very young infants were not sufficiently developed for them to feel or retain subsequent memories of pain and did not want to run the risk of administering pain-relieving drugs to such small patients.

In recent years, though, research has provided "unequivocal evidence that (young infants) are more sensitive to pain," said Dr. Nirmala Desai, a UK neonatologist who is overseeing the research.

If the current study shows morphine to lead to better results for premature infants, "I feel like that would become the standard of care," Desai said.

A preliminary study published earlier this year in the Archives of Pediatric and Adolescent Medicine suggested that the pain and stress of being on a ventilator can cause infants to struggle, leading to bleeding in the brain, softening of brain tissue and even death. UK researchers also participated in that study.

"They don't allow the respirator to breathe for them," Desai said. "They fight it. That causes disturbances in the blood flow to the brain."

The preliminary study also indicated that giving pain medication to infants on ventilators might reduce their rate of neurological injury a hypothesis which is the basis for the current research.

The randomized study, which is to last three years, is open to premature infants who are on ventilators for more than three days and who are born at less than 32 weeks gestation. The University of Arkansas is conducting the research.

Infants entering the study will be randomly assigned to receive either a constant low dose of morphine or a placebo. Any of the placebo-receiving infants who show signs of pain or discomfort will also be given morphine.

Appearing at a news conference with Desai and Dr. Thomas Pauly, the medical director of the UK Children's Hospital, were Kelly Kearns and Matt Brandon of Lexington. Their son, Austin Brandon, was born Nov. 24 after just 24½ weeks of gestation. He weighed one pound, 10 ounces.

Though she was made somewhat nervous by the prospect of her son being given morphine, Kearns said she still decided to enroll Austin in the study. "The way I understood the study, there were no disadvantages to it," she said.

"I didn't want my baby to be in pain, so it seemed to be the way to go,"> Matt Brandon said.

Because the study is "blind," neither the parents nor Desai know whether Austin is receiving morphine or a placebo.