title: Adverse Reactions - Neonatal Intensive Care Drug Manual
text: Efficacy:
  Analgesia in opioid-naïve infants: Oral analgesia with morphine for acute or chronic pain has not been systematically evaluated in neonates.
  Recommended analgesic doses of morphine sulfate for use in neonates are 0.05-0.1 mg/kg intravenously [3]. Estimated oral morphine bioavailability 48.5% in neonates [1]. (LOE IV GOR C) This equates to an estimated intermittent oral dose 0.1–0.2 mg/kg. Duration of analgesia 4–5 hours [4].
  Intravenous morphine mean steady-state serum concentration of 15 ng/mL can be achieved in children after non-cardiac surgery in an intensive care unit with a morphine hydrochloride infusion of 7.5 microgram/kg/hour at birth (term neonates), 12.5 microgram/kg/hour at 1 month, 20 microgram/kg/hour at 3 months [5, 6]. [LOE IV] As oral morphine bioavailability in neonates averaged 48.5% [1], initial estimated daily oral morphine dose is 360 microgram/day (term infants); 600 microgram/day (at 1 month); 960 micrograms/day (at 3 months) in 4–6 equally divided doses.
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