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


METHODS
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 microg/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 microg/kg/h, and total duration of therapy was 19 days. No significant adverse effects were directly attributed to dexmedetomidine use during this time.


CONCLUSIONS
Dexmedetomidine is a novel alpha(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.
O'Mara
Keliana
K
Women's Hospital of Greensboro, Greensboro, NC, USA.
Gal
Peter
P
Ransommd
J Laurence
JL
Wimmermd
John E
JE
Carlosmd
Rita Q
RQ
Dimaguilamd
Mary Ann Vt
MA
Davonzomd
Christie
C
Smithmd
McCrae
M
D020927:Dexmedetomidine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011595:Psychomotor Agitation / Q000188:drug therapy; D012121:Respiration, Artificial; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine