Dexmedetomidine Versus Fentanyl for Neonates With Hypoxic Ischemic Encephalopathy Undergoing Therapeutic Hypothermia

J Pediatr Pharmacol Ther. 2022;27(4):352-357. doi: 10.5863/1551-6776-27.4.352. Epub 2022 May 9.


Objective: Therapeutic hypothermia reduces the risk of death and major disability in neonates with moderate-to-severe hypoxic ischemic encephalopathy (HIE). Opioids and benzodiazepines are used to manage agitation but contribute to hemodynamic and respiratory instability. The objective of this study was to evaluate the safety and efficacy of dexmedetomidine (DEX) compared with fentanyl (FENT) in neonates with HIE undergoing therapeutic hypothermia.

Methods: This was a retrospective, single-center study comparing outcomes in neonates with HIE undergoing therapeutic hypothermia who received FENT to those who received DEX.

Results: A total of 45 neonates were included (FENT, n = 19; DEX, n = 26). The DEX group had a decreased need for sedative bolus doses during therapeutic hypothermia compared with the FENT group; however, there was no difference in number of uncontrolled agitation scores or need for additional scheduled sedatives. The DEX group had a shorter time to discontinuation of sedatives after rewarming compared with the FENT group (0.52 versus 5 days, respectively; p = 0.001), shorter time to extubation after birth (3.1 versus 11.3 days, respectively; p = 0.004), and earlier time to resumption of feeds (8.5 versus 13 days, respectively; p = 0.03). A non-statistically significant reduction in seizures was noted (3 versus 7 subjects, respectively; p = 0.07). There was no difference in baseline characteristics, mortality, or adverse effects.

Conclusions: The use of DEX during therapeutic hypothermia for HIE appears to provide comparable control of agitation to FENT with a reduced need for additional sedatives and may lead to an earlier time to extubation and discontinuation of sedatives.

Keywords: benzodiazepines; dexmedetomidine; hypoxic ischemic encephalopathy; neonatal; opioids; sedation; therapeutic hypothermia.