Opioid equipotency conversions for hospitalized infants: a systematic review

Related Experiment Video

Updated: Jun 12, 2025

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
06:59

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Published on: November 9, 2016

30.4K

Madeleine C Ing1,2, Olivia A Keane1, Ashwini Lakshmanan3

  • 1Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|September 20, 2024
PubMed

Insights

Standardized opioid conversions for hospitalized infants are lacking, impacting neurodevelopment. This review found wide variations in morphine milligram equivalents (MME) calculations, highlighting the need for infant-specific guidelines.

Area of Science:

  • Neonatal pharmacology and pain management
  • Pediatric neurodevelopmental research
  • Evidence-based medicine and clinical practice guidelines

Background:

  • Hospitalized infants frequently receive opioids for pain and procedural distress.
  • Opioid exposure significantly impacts infant neurodevelopment, with limited data on safe conversions.
  • Current opioid stewardship for infants is inconsistent due to a lack of standardized equipotency conversions.

Purpose of the Study:

  • To systematically review opioid dosing conversions used in hospitalized infants under one year of age.
  • To identify and analyze the variability in morphine milligram equivalents (MME) calculations for pediatric opioid use.

Main Methods:

  • Systematic literature review of fourteen articles documenting or citing opioid exposure calculations in infants.
  • Analysis of identified opioid conversion factors and equipotency equations.

Main Results:

  • Significant variability was found in morphine milligram equivalents (MME) conversion factors.
  • Nine studies utilized adult-derived conversion equations, which may not be appropriate for infant physiology.
  • No standardized equipotency opioid conversions were identified for hospitalized infants.

Conclusions:

  • Evidence-based consensus on opioid equipotency dose conversions is crucial for safe opioid stewardship in infants.
  • Future efforts must consider the unique physiological differences of infants when establishing opioid conversion guidelines.
  • Standardized conversions are needed to mitigate risks associated with cumulative and prolonged opioid exposure in neonates.

More Related Videos

Anesthesia and Intubation of Preadolescent Mouse Pups for Cardiothoracic Surgery09:47

Anesthesia and Intubation of Preadolescent Mouse Pups for Cardiothoracic Surgery

Published on: June 2, 2022

2.3K
Guidelines for Elective Pediatric Fiberoptic Intubation11:19

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

17.5K

Related Concept Videos

Factors Affecting Drug Response: Overview01:21

Factors Affecting Drug Response: Overview

When it comes to infants and young children, they are typically administered smaller doses of medication in comparison to adults. This is primarily because their organ functions still need to fully develop, meaning their bodies are not as efficient at metabolizing or eliminating drugs. Additionally, their blood-brain barrier is more permeable than in adults. As a result, high concentrations of drugs can easily penetrate the central nervous system (CNS), potentially leading to neurological...
1.9K
Opioid Analgesics: Synthetic and Semisynthetic Opioids01:15

Opioid Analgesics: Synthetic and Semisynthetic Opioids

Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
246
Opioid Analgesics: Morphine and Other Natural Cogeners01:20

Opioid Analgesics: Morphine and Other Natural Cogeners

Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
192
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
111
One-Compartment Open Model for IV Bolus Administration: General Considerations01:19

One-Compartment Open Model for IV Bolus Administration: General Considerations

The one-compartment model is a pharmacokinetic tool that models the body as a single, uniform compartment, facilitating the understanding of drug distribution and elimination. This model is particularly beneficial for intravenous (IV) bolus administration, where the drug rapidly circulates throughout the body.
The drug's presence in the body is defined by an equation representing the difference between the rates of drug entry and exit. Key parameters—elimination rate constant,...
170
Analgesia and Pain Management01:25

Analgesia and Pain Management

Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
551