National Institute for Health and Care Excellence Final Specialist neonatal respiratory care for babies born preterm [E] Evidence reviews for sedation and analgesia NICE guideline NG124 Evidence reviews April 2019 Final These evidence reviews were developed by the National Guideline Alliance, hosted by the Royal College of Obstetricians and Gynaecologists FINAL Error! No text of specified style in document. Disclaimer The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian. Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties. NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn. Copyright © NICE 2019. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3339-6 FINAL Contents Contents Sedation and analgesia....................................................................................................... 7 Review question 5.1 What is the effectiveness of morphine during respiratory support? ................................................................................................................ 8 Introduction ........................................................................................................... 8 Summary of the protocol ....................................................................................... 8 Clinical evidence ................................................................................................... 9 Summary of clinical studies included in the evidence review ................................. 9 Quality assessment of clinical studies included in the evidence review ............... 12 Economic evidence ............................................................................................. 12 Economic model .................................................................................................. 12 Clinical evidence statements ............................................................................... 12 Economic evidence statements ........................................................................... 18 The committee’s discussion of the evidence ........................................................ 18 References .......................................................................................................... 20 Review question 5.2 What is the effectiveness of using premedication for intubation in preterm babies? ............................................................................................... 22 Introduction ......................................................................................................... 22 Summary of the protocol ..................................................................................... 22 Clinical evidence ................................................................................................. 23 Summary of clinical studies included in the evidence review ............................... 24 Quality assessment of clinical studies included in the evidence review ............... 26 Economic evidence ............................................................................................. 26 Economic model .................................................................................................. 26 Clinical evidence statements ............................................................................... 27 Economic evidence statements ........................................................................... 35 The committee’s discussion of the evidence ........................................................ 35 References .......................................................................................................... 37 Appendices ........................................................................................................................ 39 Appendix A – Review protocols .................................................................................... 39 Review protocol for question 5.1 What is the effectiveness of morphine during respiratory support? ................................................................................. 39 Review protocol for question 5.2 What is the effectiveness of using premedication for intubation in preterm babies? ....................................... 44 Appendix B – Literature search strategies .................................................................... 51 Literature search strategies for question 5.1 What is the effectiveness of morphine during respiratory support? ....................................................... 51 Literature search strategies for question 5.2 What is the effectiveness of using premedication for intubation in preterm babies? ....................................... 58 Appendix C – Clinical evidence study selection ............................................................ 65 4 FINAL Contents Clinical evidence study selection for question 5.1 What is the effectiveness of morphine during respiratory support? ....................................................... 65 Clinical evidence study selection for question 5.2 What is the effectiveness of using premedication for intubation in preterm babies? ............................. 66 Appendix D – Clinical evidence tables .......................................................................... 67 Clinical evidence tables for question 5.1 What is the effectiveness of morphine during respiratory support? ...................................................................... 67 Clinical evidence tables for question 5.2 What is the effectiveness of using premedication for intubation in preterm babies? ....................................... 85 Appendix E – Forest plots........................................................................................... 100 Forest plots for question 5.1 What is the effectiveness of morphine during respiratory support? ............................................................................... 100 Forest plots for question 5.2 What is the effectiveness of using premedication for intubation in preterm babies? ............................................................ 101 Appendix F – GRADE tables ...................................................................................... 102 GRADE tables for question 5.1 What is the effectiveness of morphine during respiratory support? ............................................................................... 102 GRADE tables for question 5.2 What is the effectiveness of using premedication for intubation in preterm babies? ..................................... 109 Appendix G – Economic evidence study selection ...................................................... 123 Economic evidence study selection for question 5.1 What is the effectiveness of morphine during respiratory support? ................................................. 123 Economic evidence study selection for question 5.2 What is the effectiveness of using premedication for intubation in preterm babies? ....................... 124 Appendix H – Economic evidence tables .................................................................... 125 Economic evidence table for question 5.1 What is the effectiveness of morphine during respiratory support? ..................................................... 125 Economic evidence table for question 5.2 What is the effectiveness of using premedication for intubation in preterm babies? ..................................... 125 Appendix I – Economic evidence profiles ................................................................... 126 Economic evidence profile for question 5.1 What is the effectiveness of morphine during respiratory support? ..................................................... 126 Economic evidence profile for question 5.2 What is the effectiveness of using premedication for intubation in preterm babies? ..................................... 126 Appendix J – Health economic analysis ...................................................................... 127 Health economic analysis for question 5.1 What is the effectiveness of morphine during respiratory support? ..................................................... 127 Health economics analysis for question 5.2 What is the effectiveness of using premedication for intubation