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Background and Objective <p>Therapeutic hypothermia (TH) is the standard of care for neonates with hypoxic-ischemic encephalopathy (HIE), but effective sedation remains a challenge. Opioids are widely used but are associated with respiratory depression, delayed enteral feeding, and neurodevelopmental concerns. This study assessed the efficacy, safety, and dose–response profile of dexmedetomidine as an alternative sedative.</p> Methods <p>In this single-center retrospective cohort study, 163 neonates with HIE receiving TH between 2018 and 2024 were evaluated. Outcomes were compared between those receiving dexmedetomidine-based sedation (<i>n</i> = 61) versus opioid-only sedation (<i>n</i> = 102). Primary outcomes included cumulative opioid dose, sedation adequacy (NPASS), bradycardia &lt;80 bpm incidence, and respiratory support needs.</p> Results <p>Dexmedetomidine was associated with 50% lower cumulative opioid exposure (46 vs. 95 μg/kg, <i>p</i> &lt; 0.001), fewer rescue doses (3.3 vs. 5.0), shorter time to full enteral feeding (6 vs. 7 days, <i>p</i> &lt; 0.001), and reduced mechanical ventilation (8.5% vs. 17%, <i>p</i> = 0.14). Sedation scores and hemodynamics were comparable. Bradycardia occurred in 41% of dexmedetomidine-treated neonates, leading to discontinuation in 30%. Dose–response analysis suggested efficacy plateaued above 0.5 μg/kg/hr, with increasing bradycardia risk.</p> Conclusion <p>Dexmedetomidine was effective and generally well tolerated during TH. Infusion rates between 0.25 and 0.5 μg/kg/hr may optimize the balance of efficacy and safety.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Dexmedetomidine use during therapeutic hypothermia in neonates with HIE reduced opioid exposure by 50% while maintaining sedation efficacy.</p> </ItemContent> <ItemContent> <p>Associated with earlier achievement of full enteral feeding and lower rates of mechanical ventilation compared with opioid-only sedation.</p> </ItemContent> <ItemContent> <p>Dose–response analysis identified an infusion range (0.25–0.5 μg/kg/hr) balancing sedation efficacy with bradycardia risk.</p> </ItemContent> <ItemContent> <p>Findings support dexmedetomidine as a viable first-line sedative during therapeutic hypothermia and inform safer dosing strategies.</p> </ItemContent> </UnorderedList></p>

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Dexmedetomidine versus opioids for sedation during therapeutic hypothermia in neonatal HIE: efficacy, safety, and dose-response relationship

  • 期刊论文

  • 发表日期：

    2026年2月26日

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  • Athanasios Chamzas,
  • Fulden Aycan,
  • Mathangi Gopalakrishnan,
  • Dina El Metwally

摘要

Background and Objective

Therapeutic hypothermia (TH) is the standard of care for neonates with hypoxic-ischemic encephalopathy (HIE), but effective sedation remains a challenge. Opioids are widely used but are associated with respiratory depression, delayed enteral feeding, and neurodevelopmental concerns. This study assessed the efficacy, safety, and dose–response profile of dexmedetomidine as an alternative sedative.

Methods

In this single-center retrospective cohort study, 163 neonates with HIE receiving TH between 2018 and 2024 were evaluated. Outcomes were compared between those receiving dexmedetomidine-based sedation (n = 61) versus opioid-only sedation (n = 102). Primary outcomes included cumulative opioid dose, sedation adequacy (NPASS), bradycardia <80 bpm incidence, and respiratory support needs.

Results

Dexmedetomidine was associated with 50% lower cumulative opioid exposure (46 vs. 95 μg/kg, p < 0.001), fewer rescue doses (3.3 vs. 5.0), shorter time to full enteral feeding (6 vs. 7 days, p < 0.001), and reduced mechanical ventilation (8.5% vs. 17%, p = 0.14). Sedation scores and hemodynamics were comparable. Bradycardia occurred in 41% of dexmedetomidine-treated neonates, leading to discontinuation in 30%. Dose–response analysis suggested efficacy plateaued above 0.5 μg/kg/hr, with increasing bradycardia risk.

Conclusion

Dexmedetomidine was effective and generally well tolerated during TH. Infusion rates between 0.25 and 0.5 μg/kg/hr may optimize the balance of efficacy and safety.

Impact

Dexmedetomidine use during therapeutic hypothermia in neonates with HIE reduced opioid exposure by 50% while maintaining sedation efficacy.

Associated with earlier achievement of full enteral feeding and lower rates of mechanical ventilation compared with opioid-only sedation.

Dose–response analysis identified an infusion range (0.25–0.5 μg/kg/hr) balancing sedation efficacy with bradycardia risk.

Findings support dexmedetomidine as a viable first-line sedative during therapeutic hypothermia and inform safer dosing strategies.