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Successful Use of Dexmedetomidine for Sedation in a 24-Week Gestational Age Neonate

Neonatal Pharmacotherapy Fellow, Women's Hospital of Greensboro, Greensboro, NC

Peter Gal, PharmD BCPS FCCP FASHP

Director, Graduate Pharmacy Education, Greensboro Area Health Education Center; Clinical Professor, Eshelman School of Pharmacy, University of North Carolina; Pharmacotherapy Specialist and Fellowship Director, Department of Neonatal Medicine, Women's Hospital of Greensboro

J Laurence RansomMD

Director, Department of Neonatal Medicine, Women's Hospital of Greensboro

John E WimmerMD Jr

Neonatologist, Department of Neonatal Medicine, Medical Director of Neonatal ICU, Women's Hospital of Greensboro

Rita Q CarlosMD

Neonatologist, Department of Neonatal Medicine, Women's Hospital of Greensboro

Mary Ann VT DimaguilaMD

Neonatologist, Department of Neonatal Medicine, Women's Hospital of Greensboro

Christie DavonzoMD

Neonatologist, Department of Neonatal Medicine, Women's Hospital of Greensboro

McCrae SmithMD

Neonatologist, Department of Neonatal Medicine, Women's Hospital of Greensboro

Reprints: Dr. Gal, Greensboro AHEC, Moses Cone Health System, 200 E. Northwood St., Greensboro, NC 27401, fax 336/832-2851, peter.gal{at}mosescone.com

OBJECTIVE: To describe a case of dexmedetomidine use for sedation in a 24-week gestational age premature neonate.

CASE SUMMARY: A 9-day-old, 24-week gestational age male neonate on high-frequency oscillatory mechanical ventilation was experiencing severe agitation refractory to high-dose intravenous narcotics and benzodiazepines. Since the infant's respiratory stability was reliant on adequate sedation, he was given dexmedetomidine after several days of suboptimal response to escalation of standard agents. Treatment prior to dexmedetomidine included continuous-infusion fentanyl 10 µg/kg/h, intravenous lorazepam 0.6 mg/kg every 4 hours, intermittent doses of both lorazepam and midazolam as needed, and a single bolus dose of phenobarbital. The patient calmed markedly during the dexmedetomidine loading dose infusion and remained adequately sedated while the drug was continued. The dexmedetomidine infusion allowed weaning of mechanical ventilation settings and eventual extubation of the infant, as well as rapid tapering of other sedative medications. The maximum dexmedetomidine infusion rate was 0.7 µg/kg/h, and total duration of therapy was 19 days. No significant adverse effects were directly attributed to dexmedetomidine use during this time.

DISCUSSION: Dexmedetomidine is a novel ₂-agonist approved for short-term sedation in mechanically ventilated adults. Data describing its use in pediatric and neonatal patients continue to emerge. The prolonged use of dexmedetomidine in very-low-birth-weight neonates has not been described in the literature.

CONCLUSIONS: Dexmedetomidine was an effective sedative and analgesic in a 24-week gestational age neonate treated for refractory agitation while on mechanical ventilation. Based on its documented efficacy for pain and sedation and its favorable adverse effect profile, dexmedetomidine warrants further study as first-line or adjunct therapy with narcotics for sedation in ventilated newborns.

Key Words: dexmedetomidine, premature neonate, sedation

Published Online, September 15, 2009. www.theannals.com, DOI 10.1345/aph.1M245