The effect of morphine in the development of neonatal cholestasis in extremely preterm neonates

Background Morphine is commonly used in ventilated neonates as an analgesic with many side effects like respiratory depression and hypotension. Only a few studies have investigated morphine’s influence on biliary tract dynamics. Therefore, we planned this study to find out the relationship between morphine and liver function in preterm neonates. Methods This retrospective study was conducted at the Women’s Wellness and Research Centre by reviewing the case records of neonates admitted between 01 st January 2015 and 31 st December 2020. Preterm infants on mechanical ventilation, between gestational ages (GA) ≥24 and ≤37 weeks, were included in the study. Participants were divided into two groups according to morphine use, and liver function test values were compared, including direct (DB), total bilirubin (TB), alanine transaminase (ALT), and aspartate transaminase (AST). Results The study comprised 133 preterm newborns; out of them, 73 received morphine (Group A) and 60 did not receive it (Group B). The mean GA was 29.90 ± 5.18 weeks, and birth weight was 1250 ± 418 grams. At admission, DB levels were higher in group B than in group A (54.71 ± 50.0 vs. 36.77 ± 48.53, p = .038). However, the peak and discharge values were higher in group A than in group B ( p = .001 and p = .196, respectively). The peak AST, DB, and TB values were higher in group A. Conclusion The present study showed the impact of morphine on liver function in preterm neonates and the possibility of morphine hepatotoxicity. Clinicians should use morphine cautiously in preterm neonates to avoid the risk of developing cholestasis and hepatotoxicity.