Using of dexmedetomidine in term neonates with hypoxic-ischemic encephalopathy
DOI:
https://doi.org/10.26641/2307-0404.2019.2.170123Keywords:
hypoxia, ischemia, encephalopathy, dexmedetomidine, neonates, mechanical ventilationAbstract
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This is a corrected version. See correction statement in: https://medpers.dmu.edu.ua/en/2021-vol-xxvi/n-3
doi: https://doi.org/10.26641/2307-0404.2021.3.242347
The negative impacts of standard pharmacologic sedative agents suggest that alternative agents should be investigated. Dexmedetomidine could be the new option for sedation in newborns with hypoxic-ischemic encephalopathy requiring mechanical ventilation. The aim – to compare cerebral blood flow indexes and results of treatment for hypoxic-ischemic encephalopathy between groups of full-term infants who received dexmedetomidine (study group) and other sedatives (control group) during therapeutic hypothermia period. Data of 205 term infants with hypoxic-ischemic encephalopathy by Sarnat scale stage II-III were collected during ≤72 hours of life. Infants of the study group (n = 46) received dexmedetomidine during mechanical ventilation for pharmacological sedation. Control group infants (n = 159) received morphine, sodium oxybutiras, and diazepam in standard recommended doses. A comparative analysis of the effect of dexmedetomidine and other drugs on cerebral perfusion and outcomes of hypoxic-ischemic encephalopathy was performed. A significant difference between groups in days of trachea extubation (p=0.022) was found; the chance for babies to be extubated before the 7th day of treatment was significantly higher in the dexmedetomidine group 68% versus 33% in the control group (p=0.018) with HR 0.48 (95% CI 0.27-0.86, p=0.011). Also, the NIRS index rScO2 differed significantly between the studied and control groups on the 1st day of treatment (65% versus 79%, p=0.012) and on the 2nd day of treatment (74% versus 81%, p=0.035). Mean arterial pressure was higher in the dexmedetomidine group compared to the control group – (58 [51-65] mm Hg versus 53 [46-60] mm Hg, p<0.001), with a lower dose of dobutamine (EV -1.87, 95% CI from -3.25 to -0.48, p=0.009). In the dexmedetomidine group, the rate of seizures was significantly lower on the 1st day of observation (4.3% versus 48.3%, p <0.001); the incidence of unfavorable outcome such as cerebral leukomalacia was also 7 times lower in the dexmedetomidine group compared to the control group (2.2% versus 15.1%, p=0.018). The determined peculiarities give grounds to use dexmedetomidine in the daily practice of the neonatal intensive care, but additional data needs to be collected before any further conclusions can be drawn.
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