title: Dexmedetomidine versus standard therapy with fentanyl for sedation in mechanically ventilated premature neonates.
abstract: OBJECTIVE
  To compare the efficacy and safety of dexmedetomidine and fentanyl for sedation in mechanically ventilated premature neonates.
  
  
  METHODS
  This was a retrospective, observational case-control study in a level III neonatal intensive care unit. Forty-eight premature neonates requiring mechanical ventilation were included. Patients received fentanyl (n=24) or dexmedetomidine (n=24) for pain or sedation. Each group also received fentanyl and lorazepam boluses as needed for agitation. The primary outcomes were efficacy and frequency of acute adverse events associated with each drug. Days on mechanical ventilation, stooling patterns, feeding tolerance, and neurologic outcomes were also evaluated.
  
  
  RESULTS
  There were no significant differences in baseline demographics between the dexmedetomidine and fentanyl patients. Patients in the dexmedetomidine group required less adjunctive sedation and had more days free of additional sedation in comparison to fentanyl (54.1% vs. 16.5%, p<0.0001). There were no differences in hemodynamic parameters between the 2 groups. Duration of mechanical ventilation was shorter in the dexmedetomidine group (14.4 vs. 28.4 days, p<0.001). Meconium passage (7.5 vs. 22.4 days, p<0.0002) and time from initiation to achievement of full enteral feeds (26.8 vs. 50.8 days, p<0.0001) were shorter in the dexmedetomidine group. Incidence of culture-positive sepsis was lower in the dexmedetomidine group (48% vs. 88%). The incidence of either severe intraventricular hemorrhage or periventricular leukomalacia was not statistically significantly reduced (2% vs. 7%).
  
  
  CONCLUSIONS
  Dexmedetomidine was safe and effective for sedation in the premature neonates included in this study. Prospective randomized-controlled trials are needed before routine use of dexmedetomidine can be recommended.
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Keliana
authors.initials: K
authors.lastname: O'Mara
authors.forename: Peter
authors.initials: P
authors.lastname: Gal
authors.forename: John
authors.initials: J
authors.lastname: Wimmer
authors.forename: J Laurence
authors.initials: JL
authors.lastname: Ransom
authors.forename: Rita Q
authors.initials: RQ
authors.lastname: Carlos
authors.forename: Mary Ann V T
authors.initials: MA
authors.lastname: Dimaguila
authors.forename: Christie C
authors.initials: CC
authors.lastname: Davanzo
authors.forename: McCrae
authors.initials: M
authors.lastname: Smith