Trial reportClinical pharmacokinetics2014
Evidence-based morphine dosing for postoperative neonates and infants.
Trial report in Clinical pharmacokinetics, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 81 citations in OpenAlex.
- Intermittent intravenous paracetamol versus continuous morphine in infants undergoing cardiothoracic surgery: a multi-center randomized controlled trial.Critical care (London, England) · 2024Trial
- Quantifying the Pharmacodynamics of Morphine in the Treatment of Postoperative Pain in Preverbal Children.Journal of clinical pharmacology · 2022Trial
- Pharmacokinetics of morphine in encephalopathic neonates treated with therapeutic hypothermia.PloS one · 2019Trial
- Pharmacological therapy of neonatal analgosedation: current status, dilemmas, and perspectives.Frontiers in pediatrics · 2026Review
- Article
- Biomarkers for assessing pain and pain relief in the neonatal intensive care unit.Frontiers in pain research (Lausanne, Switzerland) · 2024Review
- Association between opioid use during mechanical ventilation in preterm infants and evidence of brain injury: a propensity score-matched cohort study.EClinicalMedicine · 2023Article
- Off-Label, but on-Evidence? A Review of the Level of Evidence for Pediatric Pharmacotherapy.Clinical pharmacology and therapeutics · 2022Review
- Recent advances in the ontogeny of drug disposition.British journal of clinical pharmacology · 2022Review
- Rescue Paracetamol in Postoperative Pain Management in Extremely Low Birth Weight Neonates Following Abdominal Surgery: A Single Unit Retrospective Study.Frontiers in pediatrics · 2022Article
- External Model Performance Evaluation of Twelve Infliximab Population Pharmacokinetic Models in Patients with Inflammatory Bowel Disease.Pharmaceutics · 2021Article
- Current State of Analgesia and Sedation in the Pediatric Intensive Care Unit.Journal of clinical medicine · 2021Review
- Model-Informed Precision Dosing of Antibiotics in Pediatric Patients: A Narrative Review.Frontiers in pediatrics · 2021Review
- Model-Informed Bayesian Estimation Improves the Prediction of Morphine Exposure in Neonates and Infants.Therapeutic drug monitoring · 2020Article
- Electronic Health Record-Embedded Decision Support Platform for Morphine Precision Dosing in Neonates.Clinical pharmacology and therapeutics · 2020Article
- A Review of Regional Anesthesia in Infants.Paediatric drugs · 2019Review
- The Ontogeny of UDP-glucuronosyltransferase Enzymes, Recommendations for Future Profiling Studies and Application Through Physiologically Based Pharmacokinetic Modelling.Clinical pharmacokinetics · 2019Review
- Suggestions for Model-Informed Precision Dosing to Optimize Neonatal Drug Therapy.Journal of clinical pharmacology · 2019Review
- Article
- Precision Dosing: Public Health Need, Proposed Framework, and Anticipated Impact.Clinical and translational science · 2017Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectivesFrom a previously validated paediatric population pharmacokinetic model, it was derived that non-linear morphine maintenance doses of 5 μg/kg(1.5)/h, with a 50 % dose reduction in neonates with a postnatal age (PNA) <10 days, yield similar morphine and metabolite concentrations across patients younger than 3 years. Compared with traditional dosing, this model-derived dosing regimen yields significantly reduced doses in neonates aged <10 days.
methodsConcentration predictions of the population model were prospectively evaluated in postoperative term neonates and infants up to the age of 1 year who received morphine doses according to the model-derived algorithm. The efficacy of this dosing algorithm was evaluated using morphine rescue medication and actual average infusion rates.
resultsMorphine and metabolite concentrations were accurately predicted by the paediatric pharmacokinetic morphine model. With regard to efficacy, 5 out of 18 neonates (27.8 %) with a PNA of <10 days needed rescue medication versus 18 of the 20 older patients (90 %) (p = 0.06). The median (interquartile range [IQR]) total morphine rescue dose was 0 (0-20) μg/kg in younger patients versus 193 (19-362) μg/kg in older patients (p = 0.003). The median (IQR) actual average morphine infusion rate was 4.4 (4.0-4.8) μg/kg/h in younger patients versus 14.4 (11.3-23.4) μg/kg/h in older patients (p < 0.001).
conclusionMorphine paediatric dosing algorithms corrected for pharmacokinetic differences alone yield effective doses that prevent over-dosing for neonates with a PNA <10 days. The fact that many neonates and infants with a PNA ≥10 days still required rescue medication warrants pharmacodynamic studies to further optimize the dosing algorithm for these patients.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.