MORPHINE REGIMEN

Pharmacy prepares morphine as a 0.5mg /0.5ml aqueous solution[DLC1] .

NAS score (score every 3 hours)	Action
Score averages ³ 8 for 3 scores	Morphine 0.5 mg/kg/day in 4 equally divided doses orally
If score persists ³8 despite morphine 0.5 mg/kg/day	Morphine 0.7 mg/kg/day in 4 equally divided doses orally
If score persists ³ 8 despite morphine 0.7 mg/kg/day	Morphine 0.9 mg/kg/day in 4 equally divided doses orally

After scores fall below treatment level for 48 hrs, the dose should be reduced by 0.05ml (0.05 mg) per dose every 4 days or longer, depending on the scores. The usual length of morphine treatment is 1-2 months. Cardiorespiratory monitoring should continue for 4 days or until dose is reduced.

Management of the vomiting baby: ensure that the infant is not being overfed and that the infant is being appropriately postured during and after feeding. Give the morphine before the feed. If baby has a large vomit after being given morphine, call MD for IV medication.

• If vomits within 10 minutes of dose, re-dose,
• If vomits after 10 minutes, give ½ dose,
• If baby vomits after feed, do not give further morphine (always err on side of caution).