Acta Medica Leopoliensia (Dec 2019)
Use of ultraselective derivate of clonidine for prolonged sedation in term newborns with hypoxic-ischemic encephalopathy
Abstract
Aim. To determine the impact of dexmedetomidine and other sedatives on cerebral blood flow and outcomes of hypoxic-ischemic encephalopathy in term neonates. Material and Methods. Data of 205 term infants with hypoxic-ischemic encephalopathy, Sarnat stage II-III was collected during the first Ј72 hours of life. All the infants were distributed by a simple open randomization technique depending on pharmacological sedative agents for positive pressure ventilation adaptation into two groups - a study group with administration of dexmedetomidine (n=46), and the control group (n=159), which included morphine, sodium oxybutyrate, and diazepam in standard recommended doses. A comparative analysis of the effect of morphine and other drugs on cerebral perfusion and outcomes of hypoxic-ischemic encephalopathy was performed. Results and Discussion. A significant difference between groups in terms of trachea extubation time (p=0.022) was found; the chance for infants to be extubated before 7 days of treatment was significantly higher in the dexmedetomidine group - 68% vs. 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 study and control groups at the 1st day of treatment (65 [50-73]% vs. 79 [68-85]%, p=0.012) and at the 2nd day of treatment (74 [67-86]% vs. 81 [73-93]%, p=0.035). Mean arterial pressure was higher in the dexmedetomidine group compared to the control group (58 [51-65] mm Hg vs. 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 of cerebral leukomalacia was also 7 times lower in the dexmedetomidine group compared with the control group (2.2% versus 15.1%, p=0.018). Conclusions. Dexmedetomidine is a safe sedative agent with stable hemodynamics profile, with no adverse cerebral influence and with possible neuroprotective effect in term infants with hypoxic-ischemic encephalopathy, additional to standard therapeutic hypothermia.
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