Dear Sir,
In their paper Roka et al. (Pediatrics 2008;121;e844-e849)
demonstrate changes in morphine concentrations in neonates with
hypothermia as a neurprotective treatment after perinatal asphyxia. The
authors addressed an important point and they should be applauded for
that.
After reading the paper, however, a number of questions remain
unanswered,. In both groups, some patients had pH values of >7.25 and
Apgar scores >7, which casts doubt on the diagnosis of perinatal
asphyxia. In addition, only 4 hypothermia and 3 normothermia infants
showed seizures, although 7 and 4 in each group, respectively, had Sarnat
2. By definition neonates with Sarnat 2 demonstrate encephalopathy
including seizures.
On page e845 the loading dose of phenobarbital is reported as 20
ìg/kg (1000 times too low), which I consider a typing error. The
cumulative dose of morphine is reported as 0.58 mg/kg per h (page e846)
which is far too high.
The authors write that ‘normothermia treatment was stopped’ (page e846).
What do they mean?
Finally, it has not been mentioned how many patients in their study had
multiple organ failure (affecting clearance of drugs, including morphine)
and how many patients received drugs competing for the enzyme UDP-
glucuronosyl-transferase (potentially influencing morphine clearance).
In papers dealing with small numbers of patients, details of
individual patients are extremely important. Unfortunately, the present
paper lacks this accuracy.
Sincerely,
Dr. Floris Groenendaal
Department of Neonatology, Wilhelmina Children’s Hospital, University
Medical Center Utrecht, Netherlands
Conflict of Interest:
None declared
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