The following is a summary of “Use of Dexmedetomidine and Opioids in Hospitalized Preterm Infants,” published in the November 2023 issue of Pediatrics by Curtis et al. 

Dexmedetomidine is not approved for use in preterm infants, but its off-label use has increased dramatically. There are no large studies characterizing dexmedetomidine use or comparing it to opioids in US NICUs.

Researchers performed a retrospective study to characterize dexmedetomidine use and its association with opioid use in premature infants in the neonatal intensive care units(NICU).

The study included preterm infants born at Pediatrix NICUs in the US from 2010 to 2020. About 395,122 infants were analyzed, with a median gestational age of 34 weeks (IQR, 32-35) and a median birth weight of 2,040 g (IQR, 1606-2440). Of these infants, 384 (0.1% of the total; 58.9% male) received dexmedetomidine. Infants who received dexmedetomidine were more likely to be born prematurely, have lower birth weights, stay in the hospital longer, be exposed to more opioids, and need mechanical ventilation for more days.

The use of dexmedetomidine increased from 0.003% in 2010 to 0.185% in 2020 (P < .001 for trend), while overall opioid exposure decreased from 8.5% in 2010 to 7.2% in 2020 (P < .001 for trend). The median postmenstrual age at the first dexmedetomidine exposure was 31 weeks (IQR, 27-36), and the median postnatal age at the first dexmedetomidine exposure was 3 days (IQR, 1-35). The median duration of dexmedetomidine receipt was 6 days (IQR, 2-14).

The study found that dexmedetomidine use increased in premature infants from 2010 to 2020 while opioid use decreased. More studies are needed to understand the long-term effects of dexmedetomidine in premature and critically ill infants.

Source: jamanetwork.com/journals/jamanetworkopen/fullarticle/2811321