Dexmedetomidine as the primary sedative in the NICU.

OBJECTIVES

To evaluate the safety and efficacy of dexmedetomidine as the primary sedative in neonates.

STUDY

DESIGN

Single center, retrospective study of mechanically ventilated neonates sedated with dexmedetomidine (study group) or opioids/benzodiazepines (control group). Primary outcome was requirement of opioids/benzodiazepines. Secondary outcomes included duration of mechanical ventilation, time to full feeds, bradycardia/hypotension, and unplanned extubation. A subgroup analysis was conducted in premature neonates.

RESULTS

There were 148 patients (study group n = 91, control group n = 57) included. Patients who received dexmedetomidine had less cumulative exposure to opioids/benzodiazepines. The median opioid/benzodiazepine requirement was 0 mg/kg/day in the study group compared to the control group with 0.36-0.96 mg/kg/day midazolam equivalents and 1.75-4.1 mg/kg/day morphine equivalents. Unplanned extubations were not different between groups indicating similar efficacy. The study group reached full feeds faster than the control group.

CONCLUSION

Dexmedetomidine as the primary sedative in neonates is safe and efficacious at minimizing opioids and benzodiazepines in both term and premature neonates.

CLINICAL TRIAL REGISTRATION: N/A.