Reviewed by Dr Carl Kuschel, Dr Simon Rowley, and Brenda Hughes
February 2001
Dose and Pharmacology Newborn Drug Protocol Index Newborn Services Home Page

Management of Oral Morphine Hydrochloride Administration




  1. Administer with a small volume of milk.
  2. When dose is <50 micrograms, dilution to 500 micrograms/ml is necessary.
  3. Using a 1 ml syringe, draw up 0.5 ml water ensuring the hub of the syringe does not contain water.
  4. Using a 2nd 1 ml syringe and needle, draw up 0.5 ml morphine hydrochloride 1 mg/ml priming hub of syringe and needle.
  5. Dispense morphine into the water and mix well.
  6. Prime to ordered dose.

Observation and Documentation

  1. Evaluate the baby's need for medication.
  2. Evaluate baby's response to medication.
  3. Assess for signs of adverse effects.
  4. Monitor respiratory status carefully.
  5. Assess oxygenation and document.
  6. Observe stools for volume and character.
  7. Record baby's dose out of the narcotic register.
  8. When diluting morphine to 500 micrograms/ml, record balance discarded out in the narcotic register.
  9. Two nurses must witness the discarding of the unused diluted drug down the sink and syringes into the sharps container.



1 Osborn D. Neonatal Abstinence Syndrome. Protocol from the Department of Neonatal Medicine, RPA Hospital, Camperdown, Sydney, Australia. June 1998
2 Wijburg FA, de Kleine MJK, Fleury P, Soepatmi S. Morphine as an anti-epileptic drug in neonatal abstinence syndrome. Acta Paediatr Scand 1991; 80 : 875-877.
3 Thomas D. Infants of drug-addicted mothers. Aust Paediatr J. 1988; 24:167-168.
4 Bhat R, Gopa C, Gulati A, Mdana 0, Velamati R, Bhargava H. Pharmacokinetics of a single dose of morphine in preterm infants during the first week of life. J Pediatr 1990; 117 : 477-81.
5 Bhat R, Abu-Harb M, Gopal C, Gulati A. Morphine metabolism in acutely ill preterm infants. J Pediatr 1992; 120: 795-9.
6 Lynn AM, Slattery JT. Morphine pharmacokinetics in early infancy. Anesthesiology 1987; 66:136-9.