Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
Division of Neurology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.
J Neonatal Perinatal Med. 2022;15(1):47-54. doi: 10.3233/NPM-210737.
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).
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.
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.
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.
在接受治疗性低温（TH）治疗的患有缺氧缺血性脑病（HIE）的新生儿中，建议镇静以优化神经保护。右美托咪定是阿片类药物的替代药物，阿片类药物通常被使用，但具有不良反应。TH 和右美托咪定都可引起心动过缓。在这项研究中，我们描述了在接受 HIE 治疗的 TH 的新生儿中使用右美托咪定和芬太尼的经验，重点是心率（HR）。
我们在 2011 年至 2019 年期间在一个四级 NICU 进行了回顾性图表审查，比较了在 HIE 接受 TH 期间使用右美托咪定（n = 14）、芬太尼（n = 120）或两者（n = 32）进行镇静的情况。根据镇静和胎龄比较了 HR 趋势。如果新生儿在出生后 24 小时内开始冷却或需要 ECMO，则排除在研究之外。
在 166 名纳入的新生儿中，46 名接受了右美托咪定，14 名作为单一疗法，32 名与芬太尼联合使用。出生后 12-36 小时的平均每小时 HR ，接受右美托咪定的婴儿明显低于接受芬太尼单一疗法的婴儿（91±9 vs. 103±11 bpm，p <0.002）。22 名（47.8％）新生儿减少或停用了右美托咪定，最常见的原因是 HR 低导致镇静不足。较低的胎龄与较高的 HR 相关，但与右美托咪定相关的 HR 趋势无显著差异。
尽管与较低的 HR 相关，但右美托咪定可能在接受 TH 治疗的患有 HIE 的新生儿中成功使用。实施标准化方案可能有助于在该人群中滴定右美托咪定。
