ArticlePediatric research2026
Dexmedetomidine versus opioids for sedation during therapeutic hypothermia in neonatal HIE: efficacy, safety, and dose-response relationship.
Article in Pediatric research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectiveTherapeutic hypothermia (TH) is the standard of care for neonates with hypoxic-ischemic encephalopathy (HIE), but effective sedation remains a challenge. Opioids are widely used but are associated with respiratory depression, delayed enteral feeding, and neurodevelopmental concerns. This study assessed the efficacy, safety, and dose-response profile of dexmedetomidine as an alternative sedative.
methodsIn this single-center retrospective cohort study, 163 neonates with HIE receiving TH between 2018 and 2024 were evaluated. Outcomes were compared between those receiving dexmedetomidine-based sedation (n = 61) versus opioid-only sedation (n = 102). Primary outcomes included cumulative opioid dose, sedation adequacy (NPASS), bradycardia <80 bpm incidence, and respiratory support needs.
resultsDexmedetomidine was associated with 50% lower cumulative opioid exposure (46 vs. 95 μg/kg, p < 0.001), fewer rescue doses (3.3 vs. 5.0), shorter time to full enteral feeding (6 vs. 7 days, p < 0.001), and reduced mechanical ventilation (8.5% vs. 17%, p = 0.14). Sedation scores and hemodynamics were comparable. Bradycardia occurred in 41% of dexmedetomidine-treated neonates, leading to discontinuation in 30%. Dose-response analysis suggested efficacy plateaued above 0.5 μg/kg/hr, with increasing bradycardia risk.
conclusionDexmedetomidine was effective and generally well tolerated during TH. Infusion rates between 0.25 and 0.5 μg/kg/hr may optimize the balance of efficacy and safety. IMPACT: Dexmedetomidine use during therapeutic hypothermia in neonates with HIE reduced opioid exposure by 50% while maintaining sedation efficacy. Associated with earlier achievement of full enteral feeding and lower rates of mechanical ventilation compared with opioid-only sedation. Dose-response analysis identified an infusion range (0.25-0.5 μg/kg/hr) balancing sedation efficacy with bradycardia risk. Findings support dexmedetomidine as a viable first-line sedative during therapeutic hypothermia and inform safer dosing strategies.
Identifiers
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.