Poppi - a single centre randomised placebo-controlled trial investigating the efficacy of morphine analgesia for procedural pain in infants
The aim of the Poppi Trial (Procedural Pain in Premature Infants) is to test whether morphine can provide effective pain relief in babies during invasive medical procedures. While morphine is frequently given to adults when they experience pain, it is not clear whether morphine provides effective pain relief in babies. This means morphine is usually not prescribed to babies when clinical staff perform clinically-essential medical procedures.
An example of a painful procedure that is frequently and regularly performed on premature babies is an eye exam that tests for Retinopathy of Prematurity – this is a disease which if untreated can lead to permanent blindness. Although the eye exam is considered to be painful, and stressful for both infants and parents, and can result in unstable breathing and heartbeat for up to 24 hours after the exam, the pain relief currently provided during this procedure, which includes sucrose, breast milk and topical eye drops, has been shown to be ineffective.
The Poppi trial will use clinical pain assessment tools to measure pain in babies during the eye exam and during a clinically-required blood test. We will test whether babies who are given morphine experience less pain, and whether this improves the stability of the babies breathing and heartbeat after the procedure. We will also use some recently developed brain-imaging techniques to observe how morphine can affect pain-related brain activity. Given that babies cannot tell us when they are in pain, this is an important new approach which will help us understand how the infant brain processes pain and will tell us whether pain-relieving drugs are effectively reducing patterns of pain-related brain activity.
- Slater R, Hartley C, Moultrie F, Adams E, Juszczak E, Rogers R, Norman J, Patel C, Stanbury K, Hoskin A, Green G, null n. A blinded randomised placebo-controlled trial investigating the efficacy of morphine analgesia for procedural pain in infants: Trial protocol [version 1; referees: awaiting peer review]. 2016;1(7).
- Hartley C, Moultrie F, Hoskin A, Green G, Monk V, Bell JL, King AR, Buckle M, van der Vaart M, Gursul D, Goksan S, Juszczak E, Norman JE, Rogers R, Patel C, Adams E, Slater R. Analgesic efficacy and safety of morphine in the Procedural Pain in Premature Infants (Poppi) study: randomised placebo-controlled trial. The Lancet. 2018;392(10164):2595-605.