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Dexmedetomidine’s effect on neonatal sedation, pain, respiratory status and cardiovascular system

Journal of Perinatology (2025)Cite this article

Subjects

Abstract

Objective

To describe the effects of dexmedetomidine on sedation, pain, respiratory status, and hemodynamics in neonates.

Methods

A retrospective study of 206 infants in a level IV NICU (2016–2021) receiving continuous dexmedetomidine infusion. Pain/sedation scores, BP, vasopressor and inotrope score (VIS), and concomitant sedatives/analgesics (CSA) were recorded before and every 3–4 h for 24 h.

Results

Median PMA:32 weeks. Hypotension occurred in 26%, primarily in infants <32weeks PMA, correlating with higher VIS and CSA. CSA use significantly predicted vasopressors/inotrope use.

Conclusion

Dexmedetomidine, with CSA, increases cardiovascular instability in preterm infants who have unique myocardial structure and function and therefore higher vulnerability.

Clinical Trial Registration (if any)

None (not applicable).

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Fig. 1: Pain and sedation scores at baseline (T1) and each subsequent time point after initiation of dexmedetomidine to the end of the study period (T5).
Fig. 2: Heart rate (HR),systolic blood pressure (SBP) accounting for time, post menstruale age (PMA), lagged dexmedetomidine dose and lagged CSA at baseline and each subsequent time point after the initiation of dexmedetomidine.
Fig. 3: FiO2 predicted by age, time and dexmedetomidine dosage.

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Data availability

The datasets presented in this article are not publicly available, as they contain de-identified data retrospectively collected from medical records, consistent with local IRB regulations. Requests regarding dataset access should be directed to the corresponding author, Marjorie M. Makoni (marjorie-mkoni@ouhsc.edu).

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Funding

The author(s) declare that financial support was received for this article’s research, authorship, and/or publication. Research reported in this publication was supported by the National Institute on Minority Health & Health Disparities of the National Institutes of Health under award Number R25MD011564. This content is solely the responsibility of the Authors and does not represent the official views of the NIH.

Author information

Authors and Affiliations

  1. Section of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Marjorie M. Makoni, Lise DeShea & Edgardo Szyld

  2. Los Angeles General Medical Center and Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Ivonne Sierra-Strum

  3. Department of Pediatrics, University of Iowa, Iowa City, IA, USA

    Adrianne R. Bischoff

  4. Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Jamie L. Miller

  5. Biomedical and Behavioral Methodology Core, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    William Howard Beasley

  6. Neonatal-Perinatal Section, Department of Pediatrics, Indiana University, Indianapolis, IN, USA

    Edgardo Szyld

Authors
  1. Marjorie M. Makoni
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Contributions

MMM conceptualized and designed the study, coordinated and supervised data collection, assisted in drafting the initial manuscript, and revised the manuscript. ISS assisted in writing the study protocol, obtaining IRB approval, collecting data, and drafting the initial manuscript and early revisions of the manuscript. ARB assisted in conceptualizing and organizing the study, conducted a comprehensive review of the manuscript, identifying areas for improvement, restructuring the paper, enhancing its flow, coherence, and overall organization. JLM provided guidance on pharmaceutical aspects of the study and assisted with writing, critically reviewing and revising the manuscript. ES guided the study’s conceptualization and design, provided a critical review, and assisted with revising the manuscript. LD advised on statistical analyses, oversaw the database and secure data storage, analyzed the data, and assisted with writing and revising the manuscript. WHB advised on statistical analyses, analyzed the data, created the graphs, and assisted with writing the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Marjorie M. Makoni.

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Competing interests

The authors declare no competing interests.

Ethics Statement

The studies involving humans were approved by the University of Oklahoma Health Sciences Center IRB. The study was conducted in accordance with the local legislation and institutional requirements. The ethics committee/institutional review board waived the requirement of written informed consent for participation from the participants or the participants’ legal guardians/next of kin because Due to the retrospective nature of the study consent was waived (IRB #13410).

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Article summary: This study describes the use and effects of dexmedetomidine across all postmenstrual ages in a neonatal intensive care unit.

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Makoni, M.M., Sierra-Strum, I., Bischoff, A.R. et al. Dexmedetomidine’s effect on neonatal sedation, pain, respiratory status and cardiovascular system. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02339-5

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