Download PDF
Am J Perinatol 2025; 42(07): 941-949
DOI: 10.1055/a-2445-3010
Original Article

Cardiorespiratory Stability in Critically Ill Preterm Infants following Dexmedetomidine Initiation

Brynne A. Sullivan 
1   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
,
Paige Howard
1   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
,
Hayley Kendrick
2   School of Pharmacy, Southern Illinois University Edwardsville, Edwardsville, Illinois
,
Brandy Zeller
3   Department of Pharmacy, St. Louis Children's Hospital, St. Louis, Missouri
,
Christopher McPherson
3   Department of Pharmacy, St. Louis Children's Hospital, St. Louis, Missouri
4   Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
,
Zachary A. Vesoulis
4   Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
› Author Affiliations Funding This work was funded by NIH/NINDS K23 NS111086 (Z.A.V.), NIH/NICHD K23 HD097254 (B.A.S.).
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective

This study aimed to evaluate cardiorespiratory status in preterm infants receiving dexmedetomidine using high-resolution physiologic data.

Study Design

We analyzed preterm infants with continuous heart rate (HR) and oxygen saturation (SpO2) data for 24 hours preceding and 48 hours following dexmedetomidine initiation. Invasive arterial blood pressure (ABP), when available, was analyzed.

Results

In 100 infants with a mean gestational age of 28 weeks and high baseline illness severity, mean HR decreased from 152 to 141 beats per minute while mean SpO2 increased from 91 to 93% in the 48 hours after dexmedetomidine initiation (p < 0.01). In 57 infants with continuous ABP monitoring, mean ABP increased from 40 to 42 mm Hg (p = 0.01). Vasoactive-inotropic support increased before and after initiation.

Conclusion

We observed cardiorespiratory changes in critically ill preterm infants following dexmedetomidine initiation; mean HR decreased and mean SpO2 increased in the 48 hours after initiation. In a subset, mean ABP increased along with vasoactive-inotropic support.

Key Points

  • Limited evidence exists on the acute cardiorespiratory effects of dexmedetomidine in preterm infants.

  • Evaluation of continuous HR, blood pressure, and oxygenation from two centers provides useful data.

  • Dexmedetomidine consistently decreased the HR of preterm infants.

  • Dexmedetomidine initiation during critical illness complicated the interpretation of physiologic effects.

  • Oxygenation stabilized after initiation during invasive mechanical ventilation.

Keywords

preterm infants - dexmedetomidine - heart rate - oxygenation - arterial blood pressure

Ethical Approval

This project was submitted and approved by the local ethics review board at the University of Virginia and Washington University at St. Louis and was approved under a waiver of consent for retrospective studies. This study was performed in accordance with the declaration of Helsinki.


Data Availability

The dataset from this study would be made available upon reasonable request from qualified investigators to the corresponding author.


Authors' Contributions

B.A.S., P.H., C.M., and Z.A.V. substantially contributed to the conception, design, analysis, and interpretation of data. H.K. and B.Z. substantially contributed to the acquisition of data. B.A.S. and C.M. drafted the article with Z.A.V. revising it critically for important intellectual content. All authors approved the final version to be published.


Supplementary Material



Publication History

Received: 12 July 2024

Accepted: 17 October 2024

Accepted Manuscript online:
18 October 2024

Article published online:
27 November 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Zimmerman KO, Smith PB, Benjamin DK. et al. Sedation, analgesia, and paralysis during mechanical ventilation of premature infants. J Pediatr 2017; 180: 99-104.e1
    CrossrefPubMedSearch in Google Scholar
  • 2 McPherson C, Miller SP, El-Dib M, Massaro AN, Inder TE. The influence of pain, agitation, and their management on the immature brain. Pediatr Res 2020; 88 (02) 168-175
    CrossrefPubMedSearch in Google Scholar
  • 3 Curtis S, Kilpatrick R, Billimoria ZC. et al. Use of dexmedetomidine and opioids in hospitalized preterm infants. JAMA Netw Open 2023; 6 (11) e2341033
    CrossrefPubMedSearch in Google Scholar
  • 4 Morton SU, Labrecque M, Moline M, Hansen A, Leeman K. Reducing benzodiazepine exposure by instituting a guideline for dexmedetomidine usage in the NICU. Pediatrics 2021; 148 (05) e2020041566
    CrossrefPubMedSearch in Google Scholar
  • 5 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 (01) e001460
    CrossrefPubMedSearch in Google Scholar
  • 6 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 (07) 628-634
    PubMedSearch in Google Scholar
  • 7 Stark A, Smith PB, Hornik CP. et al. Medication use in the neonatal intensive care unit and changes from 2010 to 2018. J Pediatr 2022; 240: 66-71.e4
    CrossrefPubMedSearch in Google Scholar
  • 8 Elliott M, Burnsed J, Heinan K. et al. Effect of dexmedetomidine on heart rate in neonates with hypoxic ischemic encephalopathy undergoing therapeutic hypothermia. J Neonatal Perinatal Med 2022; 15 (01) 47-54
    CrossrefPubMedSearch in Google Scholar
  • 9 Sellas MN, Kyllonen KC, Lepak MR, Rodriguez RJ. Dexmedetomidine for the management of postoperative pain and sedation in newborns. J Pediatr Pharmacol Ther 2019; 24 (03) 227-233
    PubMedSearch in Google Scholar
  • 10 Dersch-Mills DA, Banasch HL, Yusuf K, Howlett A. Dexmedetomidine use in a tertiary care NICU: a descriptive study. Ann Pharmacother 2019; 53 (05) 464-470
    CrossrefPubMedSearch in Google Scholar
  • 11 Dersch-Mills D, Mohammad K, Howlett A. An assessment of the impact of dexmedetomidine on opioid use in a neonatal intensive care unit. J Matern Fetal Neonatal Med 2022; 35 (15) 2836-2842
    CrossrefPubMedSearch in Google Scholar
  • 12 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 (06) 1319-1326
    CrossrefPubMedSearch in Google Scholar
  • 13 Gaies MG, Gurney JG, Yen AH. et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11 (02) 234-238
    CrossrefPubMedSearch in Google Scholar
  • 14 Chrysostomou C, Schulman SR, Herrera Castellanos M. et al. A phase II/III, multicenter, safety, efficacy, and pharmacokinetic study of dexmedetomidine in preterm and term neonates. J Pediatr 2014; 164 (02) 276-82.e1 , 3
    CrossrefPubMedSearch in Google Scholar
  • 15 Aziz K, Lee CHC, Escobedo MB. et al. Part 5: neonatal resuscitation 2020 american heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics 2021; 147 (Suppl. 01) e2020038505E
    CrossrefPubMedSearch in Google Scholar
  • 16 Vesoulis ZA, Rao R, Trivedi SB, Mathur AM. The effect of therapeutic hypothermia on heart rate variability. J Perinatol 2017; 37 (06) 679-683
    CrossrefPubMedSearch in Google Scholar
  • 17 Vrancken SL, van Heijst AF, de Boode WP. Neonatal hemodynamics: from developmental physiology to comprehensive monitoring. Front Pediatr 2018; 6: 87
    CrossrefPubMedSearch in Google Scholar
  • 18 van Straaten HL, Rademaker CM, de Vries LS. Comparison of the effect of midazolam or vecuronium on blood pressure and cerebral blood flow velocity in the premature newborn. Dev Pharmacol Ther 1992; 19 (04) 191-195
    CrossrefPubMedSearch in Google Scholar
  • 19 Anand KJS, Hall RW, Desai N. et al; NEOPAIN Trial Investigators Group. Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial. Lancet 2004; 363 (9422) 1673-1682
    CrossrefPubMedSearch in Google Scholar
  • 20 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 (07) 1069-1077
    CrossrefPubMedSearch in Google Scholar
  • 21 Lewis K, Piticaru J, Chaudhuri D. et al. Safety and efficacy of dexmedetomidine in acutely ill adults requiring noninvasive ventilation: a systematic review and meta-analysis of randomized trials. Chest 2021; 159 (06) 2274-2288
    CrossrefPubMedSearch in Google Scholar
  • 22 Taittonen MT, Kirvelä OA, Aantaa R, Kanto JH. Effect of clonidine and dexmedetomidine premedication on perioperative oxygen consumption and haemodynamic state. Br J Anaesth 1997; 78 (04) 400-406
    CrossrefPubMedSearch in Google Scholar
  • 23 Lawrence CJ, Prinzen FW, de Lange S. The effect of dexmedetomidine on the balance of myocardial energy requirement and oxygen supply and demand. Anesth Analg 1996; 82 (03) 544-550
    PubMedSearch in Google Scholar
  • 24 Gregoretti S, Henderson T, Parks DA, Gelman S. Haemodynamic changes and oxygen uptake during crossclamping of the thoracic aorta in dexmedetomidine pretreated dogs. Can J Anaesth 1992; 39 (07) 731-741
    CrossrefPubMedSearch in Google Scholar