TOP 65 - Assessment of Neurodevelopmental Outcomes in Extremely Preterm infants after Dexmedetomidine Use – A Retrospective Cohort Study

Publication Number: 3796.TOP 65

Rifkatou Tchignaha, Wake Forest Baptist Health - Brenner Children's Hospital, Winston-Salem, NC, United States; Swetha Padiyar, Wake Forest Baptist Health - Brenner Children's Hospital, Winston- Salem, NC, United States; Dustin Long, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Matthew J. Martin, Wake Forest Baptist Health - Brenner Children's Hospital, Winston-Salem, NC, United States

Background: Extremely preterm infants have a higher risk of poor neurodevelopmental outcomes with 50 percent showing moderate to severe impairment at 2 years of age. Exposure to sedative medications is common in this population due to the need for painful procedures and prolonged mechanical ventilation. Dexmedetomidine (DEX) is a highly selective alpha-2 adrenergic receptor agonist with a wide range of biologic effects, notably sedation and analgesia. Although its use has increased exponentially in the neonatal intensive care unit (NICU) due to its safety profile and prior research showing protection against neuronal apoptosis and inflammation, there is limited research on its effects on long-term neurodevelopment. Opioids such as morphine and fentanyl have been shown to increase the risk of poor long-term neurodevelopmental outcomes. This study is therefore an opportunity to explore a medication that may be a safer and effective neuroprotective sedation option in preterm infants. Findings from this study could lead to better sedation stewardship in the NICU.

Objective: The objective of our study is to compare neurodevelopmental outcomes at 24-30 months corrected age in preterm infants born < 29 weeks who were exposed to DEX and/or other sedative medications in the neonatal period.

Design/Methods: This is a retrospective observational cohort study conducted in a tertiary level 4 neonatal care facility, IRB approved. Infants ≤ 28 weeks + 6 days were included in the study. We hypothesize that infants exposed to DEX have better neurodevelopmental outcomes compared to those exposed to opioids. Infants with Grade III/ IV intraventricular hemorrhage, history of seizures or proven congenital infections, congenital brain malformations, and genetic conditions associated with poor neurodevelopmental outcomes were excluded. Infants transferred to our facility after 7 days of life were also excluded. The primary outcome is motor, language, and cognitive development. The secondary outcome focuses on common adverse effects, including bradycardia and hypotension.

Preliminary Results
A total of 411 charts were reviewed; 339 infants met inclusion criteria. Our preliminary data shows three main comparison groups: DEX with other opioids and analgesics, other opioids and analgesics, and a control group with no exposure. Our data analysis is ongoing.

Table 1: Participants by Gestational Age