Abstract Dexmedetomidine (DEX) is increasingly used for neonatal sedation, but safety data remain limited. We conducted a single-center retrospective study including neonates receiving continuous DEX infusion. Cardiorespiratory events were extracted from bedside monitoring during the 8 h before and the 24 h after initiation. Hemodynamic and clinical parameters were analyzed, and autonomic activity was assessed using Newborn Infant Parasympathetic Evaluation (NIPE) monitoring in a subgroup. Thirty-seven infants (18 preterm, 19 term) were included; 86% received concomitant morphine. Bradycardia episodes increased after DEX initiation, particularly in preterm infants (p < 0.05). In contrast, hypotension, lactate levels remained unchanged, while urine output varied over time without a clinically meaningful reduction. Hypoxemic events decreased, while oxygen requirements remained stable. In the NIPE subgroup, heart rate decreased, with a trend toward increased NIPE values. DEX was associated with increased bradycardia without clear evidence of impaired hemodynamic or respiratory tolerance. These findings suggest an overall reassuring short-term safety profile and suggest a physiologically mediated sedative effect. <Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> What is Known: • Dexmedetomidine is increasingly used for sedation in preterm and term neonates, but cardiorespiratory safety data remain limited. • Bradycardia is the most frequently reported adverse effect. What is New: • Continuous monitor-derived data show increased bradycardia after dexmedetomidine initiation, without hypotension or impaired perfusion, while hypoxemic events decreased. • Autonomic monitoring (NIPE) suggests a trend toward increased parasympathetic activity, which may reflect modulation of autonomic balance under dexmedetomidine. </entry> </row> </tbody> </tgroup> </Table>

Cardiorespiratory tolerance of continuous dexmedetomidine infusion in preterm and term newborn infants: a retrospective cohort study

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2026年5月2日

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Mathilde Blouin,
Sixtine Gilliot,
Anne Wojtanowski,
Julien De Jonckheere,
Laurent Storme,
Bertrand Decaudin,
Pascal Odou,
Kevin Le Duc,
Mohamed Riadh Boukhris

摘要

Abstract

Dexmedetomidine (DEX) is increasingly used for neonatal sedation, but safety data remain limited. We conducted a single-center retrospective study including neonates receiving continuous DEX infusion. Cardiorespiratory events were extracted from bedside monitoring during the 8 h before and the 24 h after initiation. Hemodynamic and clinical parameters were analyzed, and autonomic activity was assessed using Newborn Infant Parasympathetic Evaluation (NIPE) monitoring in a subgroup. Thirty-seven infants (18 preterm, 19 term) were included; 86% received concomitant morphine. Bradycardia episodes increased after DEX initiation, particularly in preterm infants (p < 0.05). In contrast, hypotension, lactate levels remained unchanged, while urine output varied over time without a clinically meaningful reduction. Hypoxemic events decreased, while oxygen requirements remained stable. In the NIPE subgroup, heart rate decreased, with a trend toward increased NIPE values. DEX was associated with increased bradycardia without clear evidence of impaired hemodynamic or respiratory tolerance. These findings suggest an overall reassuring short-term safety profile and suggest a physiologically mediated sedative effect.

What is Known:

• Dexmedetomidine is increasingly used for sedation in preterm and term neonates, but cardiorespiratory safety data remain limited.

• Bradycardia is the most frequently reported adverse effect.

What is New:

• Continuous monitor-derived data show increased bradycardia after dexmedetomidine initiation, without hypotension or impaired perfusion, while hypoxemic events decreased.

• Autonomic monitoring (NIPE) suggests a trend toward increased parasympathetic activity, which may reflect modulation of autonomic balance under dexmedetomidine.