The use of dexmedetomidine in the neonatal period
Authors:
J. Hálek; J. Voláková
Published in:
Čes-slov Neonat 2025; 31 (1): 56-60.
Category:
Reviews
Overview
The use of dexmedetomidine in the neonatal period
Various invasive diagnostic and therapeutic procedures are an inevitable part of the care of critically ill newborns, which entail discomfort and painful sensations. Pain not only brings suffering but also has significant negative acute and chronic health consequences. Unfortunately, there is no ideal, safe and universal means of providing sedation and analgesia in this age period. This review article outlines the potential uses of dexmedetomidine in the neonatal period.
Keywords:
Pain – newborn – analgosedation – dexmedetomidin
Sources
- Mantecón-Fernández L, Lareu-Vidal S, González-López C, Solís-Sánchez G, Suárez-Rodríguez M. Dexmedetomidine: An alternative to pain treatment in neonatology. Children (Basel) 2023; 10(3).
- Ojha S, Abramson J, Dorling J. Sedation and analgesia from prolonged pain and stress during mechanical ventilation in preterm infants: Is dexmedetomidine an alternative to current practice? BMJ Paediatr Open 2022; 6(1).
- Portelli K, Kandraju H, Ryu M, Shah PS. Efficacy and safety of dexmedetomidine for analgesia and sedation in neonates: A systematic review. J Perinatol 2024; 44(2): 164−172.
- Acun C, Ali M, Liu W, Karnati S, Fink K, Aly H. Effectiveness and safety of dexmedetomidine in neonates with hypoxic ischemic encephalopathy undergoing therapeutic hypothermia. J Pediatr Pharmacol Ther 2024; 29(3): 232−240.
- Dallefeld SH, Smith PB, Crenshaw EG, Daniel KR, Gilleskie ML, Smith DS, et al. Comparative safety profile of chloral hydrate versus other sedatives for procedural sedation in hospitalized infants. J Neonatal Perinatal Med 2020; 13(2): 159−165.
- Leister N, Yücetepe S, Ulrichs C, Pietsch S, Schink U, Kilian J, et al. Dexmedetomidine as a sole sedative for procedural sedation in preterm and neonate infants: A retrospective analysis. Paediatr Anaesth 2022; 32(8): 907−915.
- McDonald D, Palsgraf H, Shah P. Dexmedetomidine: An emerging option for sedation in neonatal patients. J Perinatol 2022; 42(7): 845−855.
- Curtis S, Kilpatrick R, Billimoria ZC, Zimmerman K, Tolia V, Clark R, et al. Use of dexmedetomidine and opioids in hospitalized preterm infants. JAMA Netw Open 2023; 6(11): e2341033.
- Chrysostomou C, Schulman SR, Herrera Castellanos M, Cofer BE, Mitra S, da Rocha MG, et al. A phase II/III, multicenter, safety, efficacy, and pharmacokinetic study of dexmedetomidine in preterm and term neonates. J Pediatr 2014; 164(2): 276−282.e1−3.
- McAdams RM, Pak D, Lalovic B, Phillips B, Shen DD. Dexmedetomidine pharmacokinetics in neonates with hypoxic-ischemic encephalopathy receiving hypothermia. Anesthesiol Res Pract 2020; 2020: 2582965.
- Yoo H, Iirola T, Vilo S, Manner T, Aantaa R, Lahtinen M, et al. Mechanism-based population pharmacokinetic and pharmacodynamic modeling of intravenous and intranasal dexmedetomidine in healthy subjects. Eur J Clin Pharmacol 2015; 71(10): 1197−1207.
- Chen X, Chen D, Chen P, Chen A, Deng J, Wei J, et al. Dexmedetomidine attenuates apoptosis and neurological deficits by modulating neuronal NADPH oxidase 2: Derived oxidative stress in neonates following hypoxic brain injury. Antioxidants (Basel) 2022; 11(11).
- McPherson C, Liviskie CJ, Zeller B, Vesoulis ZA. The impact of dexmedetomidine initiation on cardiovascular status and oxygenation in critically ill neonates. Pediatr Cardiol 2022; 43(6): 1319−1326.
- Tervonen M, Cajanus J, Kallio M, Huhtamäki H, Pokka T, Peltoniemi O. Adverse cardiovascular events are common during dexmedetomidine administration in neonates and infants during intensive care. Acta Paediatr 2023; 112(11): 2338−2345.
- Philipp M, Brede M, Hein L. Physiological significance of alpha(2)-adrenergic receptor subtype diversity: One receptor is not enough. Am J Physiol Regul Integr Comp Physiol 2002; 283(2): R287−R295.
- Dersch-Mills DA, Banasch HL, Yusuf K, Howlett A. Dexmedetomidine use in a tertiary care NICU: A descriptive study. Ann Pharmacother 2019; 53(5): 464−470.
- Kim CS, McLaughlin KC, Romero N, Crowley KE. Evaluation of dexmedetomidine withdrawal and management after prolonged infusion. Clin Ther 2024; 46(12): 1034−1040.
- Burbano NH, Otero AV, Berry DE, Orr RA, Munoz RA. Discontinuation of prolonged infusions of dexmedetomidine in critically ill children with heart disease. Intensive Care Med 2012; 38(2): 300−307.
- Glaess SS, Attridge RL, Christina Gutierrez G. Clonidine as a strategy for discontinuing dexmedetomidine sedation in critically ill patients: A narrative review. Am J Health Syst Pharm 2020; 77(7): 515−522.
- Liu J, Miller J, Ferguson M, Bagwell S, Bourque J. The impact of a clonidine transition protocol on dexmedetomidine withdrawal in critically ill pediatric patients. J Pediatr Pharmacol Ther 2020; 25(4): 278−287.
- Stroeder J, Dersch-Mills D. Identification of a conversion factor for dexmedetomidine to clonidine transitions. J Pediatr Pharmacol Ther 2024; 29(4): 375−378.
- Guillen-Hernandez J, Kyllonen KC, Tumin D, Rodriguez RJ. The use of dexmedetomidine in preterm infants: A single academic center experience. J Pediatr Pharmacol Ther 2023; 28(7): 628−634.
- Lim JY, Ker CJ, Lai NM, Romantsik O, Fiander M, Tan K. Dexmedetomidine for analgesia and sedation in newborn infants receiving mechanical ventilation. Cochrane Database Syst Rev 2024; 5(5): CD012361.
- Elliott M, Fairchild K, Zanelli S, McPherson C, Vesoulis Z. Dexmedetomidine during therapeutic hypothermia: A multicenter quality initiative. Hosp Pediatr 2024; 14(1): 30−36.
- Bua J, Massaro M, Cossovel F, Monasta L, Brovedani P, Cozzi G, et al. Intranasal dexmedetomidine, as midazolam-sparing drug, for MRI in preterm neonates. Paediatr Anaesth 2018; 28(8): 747−748.
- Inserra E, Colella U, Caredda E, Diplomatico M, Puzone S, Moschella S, et al. Safety and effectiveness of intranasal dexmedetomidine together with midazolam for sedation in neonatal MRI. Paediatr Anaesth 2022; 32(1): 79−81.
- Nakauchi C, Miyata M, Kamino S, Funato Y, Manabe M, Kojima A, et al. Dexmedetomidine versus fentanyl for sedation in extremely preterm infants. Pediatr Int 2023; 65(1): e15581.
- Ávila-Alzate JA, Gómez-Salgado J, Romero-Martín M, Martínez-Isasi S, Navarro-Abal Y, Fernández-García D. Assessment and treatment of the withdrawal syndrome in paediatric intensive care units: Systematic review. Medicine (Baltimore) 2020; 99(5): e18502.
- ANMF. Australasian Neonatal Medicines Formulary Consensus Group. Dexmedetomidine. [online]. 2024 [cit. 9. 12. 2024]. Dostupné z: https://www.slhd.nsw.gov.au/.
- Wolfe A, Zhang J, Lapenskie J, Downar J, Kanji S. Stability of dexmedetomidine in polyvinyl chloride bags containing 0.9% sodium chloride intended for subcutaneous infusions. Int J Pharm Compd 2021; 25(4): 330−335.
- Preslaski CR, Mueller SW, Wempe MF, MacLaren R. Stability of dexmedetomidine in polyvinyl chloride bags containing 0.9% sodium chloride injection. Am J Health Syst Pharm 2013; 70(15): 1336−1341.
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Neonatology Neonatal NurseArticle was published in
Czech and Slovak Neonatology
2025 Issue 1
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