Neonatal Drug Dosing Guidelines

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morphine Dose Adjustment in Renal Impairment

HIGH ALERT

Reserved/Restricted : Extended release capsules- prescribing and management is restricted to prescribers with Pediatric Acute Pain Service (APS), Pediatric Advanced Care Team (PACT), and hematology/oncology.

  • These dosing guidelines are intended for opioid-naive, acute pain situations. 
  • Practitioners should consider whether the patient is opioid naive and other underlying medical conditions when choosing an initial dose.
  • The Children’s Health Program is supported by an Acute Pain Service which is available for medical consultation in complex dosing situations.
  • Patients already receiving regular opioids or with cancer or chronic pain may require significantly higher or more frequent doses.
  • Converting from ORAL dose to IV dose:  divide oral dose by 3  
    Converting from IV dose to ORAL dose:  multiply IV dose by 3 
Go to NICU Parenteral Administration Information for morphine

Neonatal Abstinence Syndrome - Eat, Sleep, Console
Initial and titration

Go to clinical order set IWK MANAS "Management of Neonatal Abstinence Syndrome"

Weaning

Go to clinical order set IWK WENAS "Weaning Opioids in the Medical Management of Neonatal Abstinence Syndrome"

Analgesia/Sedation
IV Continuous
Ordered as: ____mg/kg/hour

Loading dose
0.05-0.1 mg/kg/dose IV

Initial Dosing
0.01-0.02 mg/kg/hour IV continuous

Suggested Titration
0.01 mg/kg/hour every 2 to 4 hours

Usual Range
0.01-0.02 mg/kg/hour IV continuous

Usual* Maximum:
0.04 mg/kg/hour   *May require higher doses for sedation or if switching between opioids (e.g. converting from fentaNYL to morphine)



Intermittent - Parenteral

Usual Initial Dose
0.05 mg/kg/dose IV/IM/Subcutaneous every 4 to 6 hours PRN

Usual Range
0.05-0.1 mg/kg/dose IV/IM/Subcutaneous every 4 to 6 hours PRN

Usual Maximum: 0.2 mg/kg/dose



Intermittent - Oral

Usual Initial Dose
0.08 mg/kg/dose PO every 3 to 4 hours PRN

Usual Range
0.08-0.2 mg/kg/dose PO every 3 to 4 hours PRN

Usual* Maximum: 0.3 mg/kg/dose 
*May require higher doses if switching between from IV to PO opioids (i.e. converting from IV fentanyl to PO morphine)



End of Life Care
Newborns within the Women's & Newborn Health Programs
Go to Policy 4.45 End of Life Care for Newborns within the Women's & Newborn Health Program Policy

Go to clinical order set IWK ENLICA "End of Life Care for Newborns"
Comments

Weaning Guidelines
Neonates treated with continuous infusion for 5 days or longer are more likely to develop opioid withdrawal symptoms.  Suggested wean as follows for morphine duration of:

  • 5 days or less: Wean by 30-50% every 12 to 24 hours
  • 6 to 10 days: Wean by 20% every 12 to 24 hours
  • Greater than 10 days: Wean by 10 % every 24 hours

Guidelines for conversion to oral morphine from IV Fentanyl in neonates
Go to calculator for conversion of IV fentaNYL to oral morphine in neonates

Note: this provides a rough estimate for converting IV FentaNYL to PO morphine. There is significant individual response to various opioids as well as unpredictable or incomplete tolerance between opioids; clinical judgement must always be used when converting opioids.  Neonates can be more susceptible to adverse effects of opioids therefore consider starting at a lower dose than what the conversion suggests. 

For detailed, step by step instructions on converting to oral morphine from IV fentaNYL, please see the fentaNYL drug dosing guideline.

Go to Pediatric Drug Dosing Guideline for morphine
Supplied
Capsule, Extended Release: 10 mg, 15 mg, 30 mg
Injection: 1 mg/mL (50 mL Prefilled Syringe) IWK Compounded, 1 mg/mL (100 mL Bag) , 2 mg/mL, 10 mg/mL, 0.5 mg/mL
Syrup: 1 mg/mL
Tablet: 5 mg
For more detailed information, go to Micromedex
Created on August 26, 2019 01:56 PM
Updated on January 11, 2024 09:39 AM

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