The article in this issue of Pediatrics entitled “Morphine, Hypotension, and Adverse Outcomes Among Preterm Neonates: Who’s to Blame?” is a reanalysis of a data set recently published.1,2  Before attributing blame and passing judgment, it is important to briefly review the data. Thus, the genesis of the study was based on pilot observations that suggest that morphine infusions decrease the frequency of early neurologic injury in ventilated infants. The authors extended these initial observations and conducted a multicenter, blinded, randomized trial to test the hypothesis that preemptive morphine, compared with a placebo group, would significantly reduce the frequency of early neurologic injury in ventilated preterm neonates. The primary outcome was neonatal death, severe intraventricular hemorrhage (IVH) (grade III/IV), or periventricular leukomalacia (PVL) defined as cystic echolucency adjacent to the lateral ventricles on cranial sonography obtained at 4 to 7 days and at 28 to 35 days...

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