Relieving the Pain of Preemies

Premature infants on ventilators are getting a tiny dose of morphine at the University of Kentucky Children’s Hospital, where doctors say they hope to learn whether the pain medication can improve medical results for their tiniest patients.

Ventilators are used for premature infants whose lungs are not sufficiently developed to allow them to breathe on their own. Although adults on ventilators routinely receive 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 memories of pain and did not want to run the risk of administering pain-relieving drugs to such small patients.

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In recent years, though, research has provided “unequivocal evidence that [young infants] are more sensitive to pain,” said Dr. Nirmala Desai, a University of Kentucky neonatologist overseeing the research at the hospital.

The Kentucky hospital is one of a dozen nationwide participating in the study led by the University of Arkansas and funded by the federal National Institutes of Health.

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. University of Kentucky 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 that is the basis for the current research.

The 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.

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 Dec. 21 news conference with Desai were Kelly Kearns and Matt Brandon. Their son, Austin Brandon, was born Nov. 24 after just 24 1/2 weeks of gestation and weighed 1 pound, 10 ounces.

Although she was somewhat nervous about 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,” Kearns said. “I didn’t want my baby to be in pain, so it seemed to be the way to go.”

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