Premedication for intubation with morphine causes prolonged depression of electrocortical background activity in preterm infants.

Background:Sedative and analgesic medications are used in critically ill newborns, but little is known about their effects on electrocortical activity in preterm infants. We hypothesized that morphine might induce prolonged neurodepression, independent of blood pressure, compared with rapid sequence induction/intubation (RSI).Methods:Of 34 infants enrolled into a randomized controlled trial (RCT) comparing RSI (including thiopental 2-3 mg/kg and remifentantil 1 microg/kg) with morphine (0.3 mg/kg) as premedication for intubation, 28 infants (n=14+14; median gestational age 26.1 weeks and postnatal age 138 h) had continuous two-channel amplitude-integrated electroencephalogram (aEEG/EEG) and blood pressure monitoring during 24 h after the intubation. Thirteen infants not receiving any additional medication constituted the primary study group. Visual and quantitative analyses of aEEG/EEG and blood pressure were performed in 3-h epochs.Results:RSI was associated with aEEG/EEG depression lasting less than 3 h. Morphine premedication resulted in aEEG/EEG depression with more discontinuous background and less developed cyclicity for 24 h, and during the first 9 h interburst intervals were significantly increased compared to RSI. The difference was not related to blood pressure.Conclusion:Premedication with morphine is associated with prolonged aEEG/EEG depression independent of blood pressure changes, and may not be optimal for short procedures.Pediatric Research (2012); doi:10.1038/pr.2012.153.