Searching for just a few words should be enough to get started. If you need to make more complex queries, use the tips below to guide you.
Article type: Research Article
Authors: Elliott, M.a; * | Burnsed, J.a | Heinan, K.b | Letzkus, L.c | Andris, R.d | Fairchild, K.a | Zanelli, S.a
Affiliations: [a] Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA | [b] Division of Neurology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA | [c] Division of Developmental Pediatrics, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA | [d] UVA School of Medicine, University of Virginia, Charlottesville, VA, USA
Correspondence: [*] Address for correspondence: Megan Elliott, MD, University of Virginia Hospital, PO Box 800386, Charlottesville VA 22908, USA. Tel.: +1 248 568 2707; E-mail: mkr5k@virginia.edu.
Abstract: BACKGROUND:Sedation is recommended to optimize neuroprotection in neonates with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). Dexmedetomidine is an alternative agent to opioids, which are commonly used but have adverse effects. Both TH and dexmedetomidine can cause bradycardia. In this study, we describe our experience with dexmedetomidine and fentanyl in neonates undergoing TH for HIE, with a focus on heart rate (HR). METHODS:We performed a retrospective chart review from 2011–2019 at a level IV NICU comparing sedation with dexmedetomidine (n = 14), fentanyl (n = 120), or both (n = 32) during TH for HIE. HR trends were compared based on sedation and gestational age. Neonates were included if they underwent TH and received sedation and were excluded if cooling was initiated past 24hours (h) from birth or if they required ECMO. RESULTS:Of the 166 neonates included, 46 received dexmedetomidine, 14 as monotherapy and 32 in combination with fentanyl. Mean hourly HR from 12–36 h after birth was significantly lower for infants on dexmedetomidine versus fentanyl monotherapy (91±9 vs. 103±11 bpm, p < 0.002). Dexmedetomidine was decreased or discontinued in 22 (47.8%) neonates, most commonly due to inadequate sedation with a low HR. Lower gestational age was associated with higher HR but no significant difference in dexmedetomidine-related HR trends. CONCLUSIONS:Despite an association with lower HR, dexmedetomidine may be successfully used in neonates with HIE undergoing TH. Implementation of a standardized protocol may facilitate dexmedetomidine titration in this population.
Keywords: Dexmedetomidine, neonatal hypoxic ischemic encephalopathy, therapeutic hypothermia
DOI: 10.3233/NPM-210737
Journal: Journal of Neonatal-Perinatal Medicine, vol. 15, no. 1, pp. 47-54, 2022
IOS Press, Inc.
6751 Tepper Drive
Clifton, VA 20124
USA
Tel: +1 703 830 6300
Fax: +1 703 830 2300
sales@iospress.com
For editorial issues, like the status of your submitted paper or proposals, write to editorial@iospress.nl
IOS Press
Nieuwe Hemweg 6B
1013 BG Amsterdam
The Netherlands
Tel: +31 20 688 3355
Fax: +31 20 687 0091
info@iospress.nl
For editorial issues, permissions, book requests, submissions and proceedings, contact the Amsterdam office info@iospress.nl
Inspirees International (China Office)
Ciyunsi Beili 207(CapitaLand), Bld 1, 7-901
100025, Beijing
China
Free service line: 400 661 8717
Fax: +86 10 8446 7947
china@iospress.cn
For editorial issues, like the status of your submitted paper or proposals, write to editorial@iospress.nl
如果您在出版方面需要帮助或有任何建, 件至: editorial@iospress.nl