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1.  Randomised double blind trial of morphine versus diamorphine for sedation of preterm neonates 
AIMS—To compare the safety and effectiveness of morphine and diamorphine for the sedation of ventilated preterm neonates in a double blind, randomised trial.
METHODS—Eighty eight babies were allocated to receive either morphine (n = 44) or diamorphine (n = 44) by bolus infusion (200 or 120mcg/kg, respectively, over two hours), followed by maintenance infusion (25 or 15 mcg/kg/h, respectively) during the initial phase of their respiratory disease. Serial monitoring of physiological, behavioural, and biochemical variables over the first 24 hours of the infusions was performed. Longer term outcomes were also monitored.
RESULTS—Morphine, but not diamorphine, was associated with a mean (SEM) decrease in mean arterial blood pressure of 2.2 (1.0) mm Hg (p = 0.05) over the initial loading infusion. Physiological (blood pressure variability) and behavioural measures of sedation (clinical assessment and sedation scoring) indicated that the two drug regimens were equally effective after 24 hours, but the sedative effects of diamorphine were evident more quickly than those of morphine. Both regimens significantly reduced plasma adrenaline concentrations over the first 24 hours of the infusions. No significant differences in mortality, ventilator days, chronic lung disease or intracranial lesions were noted.
CONCLUSIONS—Both drug regimens reduce the stress response to ventilation in preterm neonates. However, diamorphine's more rapid onset of sedation and morphine's hypotensive tendency suggest that diamorphine is preferable for the sedation of mechanically ventilated preterm neonates.

PMCID: PMC1720807  PMID: 9797622
2.  Can topical lignocaine reduce behavioural response to heel prick? 
In a randomised, double blind, controlled study the ability of 5% lignocaine ointment to reduce the behavioural response to heel lance in 30 healthy neonates was assessed. Five per cent lignocaine ointment applied to the heel under an occlusive dressing for one hour before heel prick did not reduce the infants' behavioural response to the heel prick procedure.
PMCID: PMC2528406  PMID: 7743286
3.  Behavioural response to pain in healthy neonates. 
A bedside technique for evaluating the behavioural response of healthy neonates to pain was assessed. Thirty six term infants (median gestational age 40 weeks; median postnatal age 4 days) and 31 preterm infants (median gestational age 34 weeks; median postnatal age 4 days) were assessed at the cotside for their response to heel preparation and heel lance for routine blood sampling. The facial actions of brow bulge, eye squeeze, nasolabial furrow, and open mouth were noted, and also the presence or absence of crying. Thirty five (97%) term and 26 (84%) preterm infants showed an increase in the number of behaviours in response to heel lance. Brow bulge and nasolabial furrow were seen most often, and occurred more often than crying in the two groups. There was good interobserver agreement (94%). The consistency of response and the high degree of interobserver agreement makes this method of behavioural assessment of acute pain of use in healthy neonates.
PMCID: PMC1061035  PMID: 8198409
4.  Effect of sucrose on crying in response to heel stab. 
Archives of Disease in Childhood  1993;69(3):388-389.
It has been suggested that sucrose acts as an analgesic in the neonatal period. To evaluate this further, 52 infants received either 2 ml of 7.5% sucrose or 2 ml of sterile water before heel stab blood sampling. The duration of crying in response to sampling did not differ in the two groups but was related to level of arousal at the time of stimulation.
PMCID: PMC1029529  PMID: 8215552
5.  Resolution of pancreatic ascites with octreotide. 
Archives of Disease in Childhood  1993;68(1):135-136.
A 7 month old infant with pancreatitis and ascites was managed successfully with subcutaneous octreotide and external drainage of a pseudocyst. An endoscopic retrograde cholangiopancreatographic examination showed no congenital abnormality and was consistent with chronic pancreatitis. Octreotide has a possible therapeutic role in pancreatic ascites.
PMCID: PMC1029202  PMID: 8434999

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