284 Opiate Administration to Preterm Infants - A Risk Factor for Necrotising Enterocolitis?

Abstract

Background: There are reports implicating early opiate exposure as a risk factor for NEC in preterm infants. Conversely, secondary analysis of the NEOPAIN trial (comparing routine morphine administration) did not show this association. We aimed to investigate if exposure to opiates in the first week was a risk factor for subsequent NEC in preterm infants in our NICU. Method: Cases of NEC (Bell Stage ≥2) in infants <32 weeks gestation age (GA) over a 3-year period (Jan 2008-Dec 2010) were identified from the NICU database. A case-control study was performed by pairing each infant with NEC to a random control, matched for year of birth, GA (±1 week) and birthweight (BW ± 20%). Total exposure to opiates (morphine and fentanyl) between days 1 and 7 was tabulated from medical records and the database. Two-tailed Fisher's exact test was used to calculate the risk Results: 27 infants with definite NEC were identified with mean GA (±SD) of 27.2(±2.1) weeks and BW of 998 (±348) g. 54 controls were matched with mean (±SD) GA 0f 27.3 (±2.2) weeks and BW of 972(±346) g. Exposure to opiates was not different between NEC and controls (P = 0.63; Odds Ratio (95% CI) of 0.73 (0.28-1.91). Median (range) daily opiate over the first week in NEC infants (morphine dose equivalent) was 14.3 (0-259) μg/kg/day or approx. 0.6 (0-11) μg/kg/hour Conclusions: Early opiate exposure did not appear to be a significant risk factor for NEC in our population. Low level of exposure may play a role. More research is required.