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Dexmedetomidine – An emerging option for sedation in neonatal patients

Journal of Perinatology volume 42, pages 845–855 (2022)Cite this article

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Abstract

Dexmedetomidine is a sedative agent with limited dosing, safety, and efficacy information in the neonatal population. This comprehensive review describes the available evidence summarizing the use of dexmedetomidine in various neonatal populations. We identified 21 studies and 1 case report supporting the efficacy and short-term safety of DEX in neonates. Reported dosing ranges from 0.5–1.5 mcg/kg/h with or without loading doses. Clinically relevant adverse effects include bradycardia and hypotension. Future studies are needed to determine long-term safety and facilitate clinical applicability.

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References

  1. Dexmedetomidine hydrochloride [package insert]. Parmaus (NJ): HQ Specialty Pharma Cooperation; 2015.

  2. Estkowski LM, Morris JL, Sinclair EA. Characterization of dexmedetomidine dosing and safety in neonates and infants. J Pediatr Pharm Ther. 2015;20:112–8.

    Google Scholar 

  3. Ard J, Doyle W, Bekker A. Awake craniotomy with dexmedetomidine in pediatric patients. J Neurosurg Anesthesiol. 2003;15:263–6.

    Article  Google Scholar 

  4. Ni J, Wei J, Yao Y, Jiang X, Luo L, Luo D. Effect of dexmedetomidine on preventing postoperative agitation in children: a meta-analysis. PLoS One. 2015;10:e0128450.

    Article  Google Scholar 

  5. Tug A, Hanci A, Turk HS, Aybey F, Isil CT, Sayin P, et al. Comparison of two different intranasal doses of dexmedetomidine in children for magnetic resonance imaging sedation. Paediatr Drugs. 2015;17:479–85.

    Article  Google Scholar 

  6. Walker J, Maccallum M, Fischer C, Kopcha R, Saylors R, McCall J. Sedation using dexmedetomidine in pediatric burn patients. J Burn Care Res. 2006;27:206–10.

    Article  Google Scholar 

  7. Greenberg RG, Wu H, Laughon M, Capparelli E, Rowe S, Zimmerman KO, et al. Population pharmacokinetics of dexmedetomidine in infants. J Clin Pharm. 2017;57:1174–82.

    Article  CAS  Google Scholar 

  8. McPherson C, Ortinau CM, Vesoulis Z. Practical approaches to sedation and analgesia in the newborn. J Perinatol. 2021;41:383–95.

    Article  Google Scholar 

  9. Puia-Dumitrescu M, Comstock BA, Li S, Heagerty PJ, Perez KM, Law JB, et al. Assessment of 2-year neurodevelopmental outcomes in extremely preterm infants receiving opioids and benzodiazepines. JAMA Netw Open. 2021;4:e2115998.

    Article  Google Scholar 

  10. Durrmeyer X, Vutskits L, Anand KJS, Rimensberger PC. Use of analgesic and sedative drugs in the NICU: integrating clinical trials and laboratory data. Pediatr Res. 2010;67:117–27.

    Article  Google Scholar 

  11. Ng E, Taddio A, Ohlsson A. Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit. Cochrane Database Syst Rev. 2017;1:CD002052.

    PubMed  Google Scholar 

  12. O’Mara K, Gal P, Wimmer J, Ransom JL, Carlos RQ, Dimagulia MAVT, et al. Dexmedetomidine versus standard therapy with fentanyl for sedation in mechanically ventilated premature neonates. J Pediatr Pharm Ther. 2012;17:252–62.

    Google Scholar 

  13. Chrysostomou C, Schulman SR, Herrera Castellanos M, Cofer BE, Mitra S, Garcia da Rocha M, et al. A phase II/III, multicenter, safety, efficacy, and pharmacokinetic study of dexmedetomidine in preterm and term neonates. J Pediatr. 2014;164:276–82.

    Article  CAS  Google Scholar 

  14. Dersch-Mills DA, Banasch HL, Yusuf K, Howlett A. Dexmedetomidine use in a tertiary care NICU: a descriptive study. Ann Pharmacother. 2019;53:464–70.

    Article  CAS  Google Scholar 

  15. van Dijkman SC, De Cock PAJG, Smets K, Decaluwe W, Smits A, Allegaert K, et al. Dose rationale and pharmacokinetics of dexmedetomidine in mechanically ventilated newborns: impact of design optimisation. Eur J Clin Pharm. 2019;75:1393–404.

    Article  Google Scholar 

  16. McAdams RM, Pak D, Lalovic B, Phillips B, Shen DD. Dexmedetomidine pharmacokinetics in neonates with hypoxic-ischemic encephalopathy receiving hypothermia. Anesthesiol Res. 2020;2582965.

  17. Gundersen JK, Chakkarapani E, Jary S, Menassa DA, Scull-Brown E, Frymoyer A, et al. Morphine and fentanyl exposure during therapeutic hypothermia does not impair neurodevelopment. EClinicalMedicine. 2021;36:100892.

    Article  Google Scholar 

  18. O’Mara K, Weiss MD. Dexmedetomidine for sedation of neonates with HIE undergoing therapeutic hypothermia: a single-center experience. AJP Rep. 2018;8:e168–e173.

    Article  Google Scholar 

  19. Cosnahan AS, Angert RM, Jano E, Wachtel EV. Dexmedetomidine versus intermittent morphine for sedation of neonates with encephalopathy undergoing therapeutic hypothermia. J Perinatol. 2021;41:2284–91.

    Article  CAS  Google Scholar 

  20. Elliott M, Burnsed J, Heinan K, Letzkus L, Andris R, Fairchild K, et al. Effect of dexmedetomidine on heart rate in neonates with hypoxic ischemic encephalopathy undergoing therapeutic hypothermia. J Neonatal Perinat Med. 2021;15:47–54. https://doi.org/10.3233/NPM-210737.

    Article  Google Scholar 

  21. Dilek O, Yasemin G, Atci M. Preliminary experience with dexmedetomidine in neonatal anesthesia. J Anaesthesiol Clin Pharm. 2011;27:17–22.

    Article  Google Scholar 

  22. Waurick K, Sauerland C, Goeters C. Dexmedetomidine sedation combined with caudal anesthesia for lower abdominal and extremity surgery in ex-preterm and full-term infants. Paediatr Anaesth. 2017;27:637–42.

    Article  Google Scholar 

  23. Bong CL, Yeo ASH, Fabila T, Tan JS. A pilot study of dexmedetomidine sedation and caudal anesthesia for inguinal hernia repair in infants. Paediatr Anaesth. 2016;26:621–7.

    Article  Google Scholar 

  24. Bong CL, Tan J, Lim S, Low Y, Sim SW, Rajadurai VS, et al. Randomised controlled trial of dexmedetomidine sedation vs general anaesthesia for inguinal hernia surgery on perioperative outcomes in infants. Br J Anaesth. 2019;122:662–70.

    Article  CAS  Google Scholar 

  25. Zuppa AF, Nicolson SC, Wilder NS, Ibla JC, Gottlieb EA, Burns KM, et al. Results of a phase 1 multicentre investigation of dexmedetomidine bolus and infusion in corrective infant cardiac surgery. Br J Anaesth. 2019;123:839–52.

    Article  CAS  Google Scholar 

  26. Zimmerman KO, Wu H, Laughon M, Greenberg RG, Walczak R, Schulman SR, et al. Dexmedetomidine pharmacokinetics and a new dosing paradigm in infants supported with cardiopulmonary bypass. Anesth Analg. 2019;129:1519–28.

    Article  CAS  Google Scholar 

  27. Lam F, Bhutta AT, Tobias JD, Gossett JM, Morales L, Gupta P. Hemodynamic effects of dexmedetomidine in critically ill neonates and infants with heart disease. Pediatr Cardiol. 2012;33:1069–77.

    Article  Google Scholar 

  28. Su F, Gastonguay MR, Nicolson SC, DiLiberto M, Ocampo-Pelland A, Zuppa AF. Dexmedetomidine pharmacology in neonates and infants after open heart surgery. Anesth Analg. 2016;122:1556–66.

    Article  CAS  Google Scholar 

  29. Sellas MN, Kyllonen KC, Lepak MR, Rodriguez RJ. Dexmedetomidine for the management of postoperative pain and sedation in newborns. J Pediatr Pharm Ther. 2019;24:227–33.

    Google Scholar 

  30. Sykes AG, Oviedo P, Rooney A, Gollin G. An assessment of dexmedetomidine as an opioid-sparing agent after neonatal open thoracic and abdominal operations. J Perinatol. 2021. https://doi.org/10.1038/s41372-021-01175-7.

    Article  PubMed  Google Scholar 

  31. Bua J, Massaro M, Cossovel F, Monasta L, Brovendani P, Cozzi G, et al. Intranasal dexmedetomidine, as midazolam-sparing drug, for MRI in preterm neonates. Paediatr Anaesth. 2018;28:747–8.

    Article  Google Scholar 

  32. Dexmedetomidine. In: Specific Lexicomp Online Database [database on the Internet]. Hudson (OH): Lexicomp Inc.: 2021 [updated 29 July 2021; cited 27 July 2021]. Available from: http://online.lexi.com. Subscription required to view.

  33. Nakano T, Okamoto H. Dexmedetomidine-induced cerebral hypoperfusion exacerbates ischemic brain injury in rats. J Anesth. 2009;23:378–84.

    Article  Google Scholar 

  34. Kubota T, Fukasawa T, Kitamura E, Magota M, Kato Y, Natsume J, et al. Epileptic seizures induced by dexmedetomidine in a neonate. Brain Dev. 2013;35:360–2.

    Article  Google Scholar 

  35. Endesfelder S, Makki H, von Haefen C, Spies CD, Bührer C, Sifringer M. Neuroprotective effects of dexmedetomidine against hyperoxia-induced injury in the developing rat brain. PLoS One. 2017;12:e0171498.

    Article  Google Scholar 

  36. Tachibana K, Hashimoto T, Kato R, Uchida Y, Ito R, Takita K, et al. Neonatal administration with dexmedetomidine does not impair the rat hippocampal synaptic plasticity later in adulthood. Paediatr Anaesth. 2012;22:713–9.

    Article  Google Scholar 

  37. Zhang Y, Gao Q, Wu Z, Xue H, Liu B, Zhao P. Dexmedetomidine promotes hippocampal neurogenesis and improves spatial learning and memory in neonatal rats. Drug Des Devel Ther. 2019;13:4439–49.

    Article  CAS  Google Scholar 

  38. Lee MM, Caylor K, Gockenbach N. Evaluating the transition from dexmedetomidine to clonidine for the prevention of withdrawal in critically ill pediatric patients. J Pediatr Pharm Ther. 2020;25:104–10.

    Google Scholar 

  39. Gagnon DJ, Riker RR, Glisic EK, Kelner A, Perrey HM, Fraser GL. Transition from dexmedetomidine to enteral clonidine for ICU sedation: an observational pilot study. Pharmacotherapy. 2015;35:251–9.

    Article  CAS  Google Scholar 

  40. Murray KL, Wright D, Laxton B, Miller KM, Meyers J, Englebright J. Implementation of standardized pediatric i.v. medication concentrations. Am J Health Syst Pharm. 2014;71:1500–8.

    Article  CAS  Google Scholar 

  41. Campos-Beata Y, Saavedra-Mitjans M, Garin N, Cardenete J, Cardona D, Riera P. Physicochemical compatibility of dexmedetomidine with parenteral nutrition. Nutr Clin Pr. 2020;35:967–72.

    Article  Google Scholar 

  42. Baserga M, DuPont TL, Ostrander B, Minton S, Sheffield M, Balch AH, et al. Dexmedetomidine use in infants undergoing cooling due to neonatal encephalopathy (DICE Trial): a randomized controlled trial: background, aims and study protocol. Front Pain Res. 2021;2:770511.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pharmacy, Children’s Regional Hospital at Cooper University Health Care, Camden, NJ, USA

    Danielle McDonald

  2. Department of Pharmacy, Children’s National Hospital, Washington, DC, USA

    Hannah Palsgraf

  3. Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, The State University of New Jersey, Hackensack University Medical Center, Piscataway, NJ, USA

    Pooja Shah

Authors
  1. Danielle McDonald
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  2. Hannah Palsgraf
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  3. Pooja Shah
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Contributions

DM and PS conceived the presented idea. DM completed original literature search and methodology. All authors contributed to analyzing literature, synthesizing results, and writing manuscripts. All authors agree to the final manuscript version.

Corresponding author

Correspondence to Danielle McDonald.

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The authors declare no competing interests.

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This study was performed in accordance with the Declaration of Helsinki.

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McDonald, D., Palsgraf, H. & Shah, P. Dexmedetomidine – An emerging option for sedation in neonatal patients. J Perinatol 42, 845–855 (2022). https://doi.org/10.1038/s41372-022-01351-3

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  • DOI: https://doi.org/10.1038/s41372-022-01351-3

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