@article{discovery1537521,
       publisher = {Oxford University Press (OUP): Policy B},
           title = {Higher risk of opioid-induced respiratory depression in children with neurodevelopmental disability: a retrospective cohort study of 12,904 patients},
            year = {2017},
         journal = {British Journal of Anaesthesia},
          number = {2},
           month = {February},
           pages = {239--246},
          volume = {118},
            note = {Copyright {\copyright} The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. This is a pre-copyedited, author-produced version of an article accepted for publication in the British Journal of Anaesthesia following peer review. The version of record [Jay, M; Thomas, BM; Nandi, R; Howard, RF; (2017) Higher risk of opioid-induced respiratory depression in children with neurodevelopmental disability: a retrospective cohort study of 12,904 patients. British Journal of Anaesthesia, 118 (2) pp. 239-246. DOI: 10.1093/bja/aew403] is available online at: https://doi.org/10.1093/bja/aew403},
        keywords = {Developmental disabilities, morphine, pain, postoperative, 
morphine, child, nurses, pain management, disability, opioids, respiratory depression, adverse event},
             url = {http://dx.doi.org/10.1093/bja/aew403},
            issn = {1471-6771},
        abstract = {BACKGROUND: Children with neurodevelopmental disabilities may be at risk of opioid-induced respiratory depression. We aimed to quantify the risks and effectiveness of morphine nurse-controlled analgesia (morphine-NCA) for postoperative pain in children with neurodevelopmental disabilities.

METHODS: We carried out a retrospective cohort study of 12 904 children who received postoperative i.v. morphine-NCA. Subjects were divided into a neurodevelopmental disability group and a control group. Rates of clinical satisfaction, respiratory depression, and serious adverse events were obtained, and statistical analysis, including multilevel logistic regression using Bayesian inference, was performed.

RESULTS: Of 12 904 patients, 2390 (19\%) had neurodevelopmental disabilities. There were 88 instances of respiratory depression and 52 serious adverse events; there were no opioid-related deaths. The cumulative incidence of respiratory depression in the neurodevelopmental disability group was 1.09\% vs 0.59\% in the control group [odds ratio 1.8 (98\% chance that the true odds ratio was {\ensuremath{>}}1)]. A significant interaction between postoperative morphine dose and neurodevelopmental disabilities was observed, with higher risk of respiratory depression with increasing dose. Satisfaction with morphine-NCA was very high overall, although children with neurodevelopmental disabilities were 1\% more likely to have infusions rated as fair or poor (3.3 vs 2.1\%, {\ensuremath{\chi}}2P{\ensuremath{<}}0.001).

CONCLUSIONS: Children with neurodevelopmental disabilities were 1.8 times more likely to suffer respiratory depression, absolute risk difference 0.5\%; opioid-induced respiratory depression in this group may relate to increased sensitivity to dose-relate respiratory effects of morphine. Morphine-NCA as described was an acceptable technique for children with and without neurodevelopmental disabilities.},
          author = {Jay, M and Thomas, BM and Nandi, R and Howard, RF}
}