326 - Comparison of Affects for Developmental Outcomes of Dexmedetomidine and Fentanyl, as Sedatives for Extremely Preterm Infants

Publication Number: 326.4208

Arika Murase, Department of Pediatrics, Fujita Health University, Kariya-city, Aichi, Japan; Masafumi Miyata, Department of pediatrics, Fujita Health University School of MEdicine, Toyoake, Aichi, Japan; Chiharuko Nakauchi, Department of pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Shigemitsu Kamino, Department of pediatrics, Fujita health university school of medicine, toyoake, Aichi, Japan; Yusuke Funato, Fijita Health University, Nagoya, Aichi, Japan; Masahiko Manabe, Fujita health university, toyoakeshi, Aichi, Japan; Arisa Kojima, Department of pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Yuri Kawai, Fujita Health University, Toyoake, Aichi, Japan; Hidetoshi Uchida, Department of Pediatrics, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan; Masayuki Fujino, Department of pediatrics, Fujita Health University of School of Medicine, Toyoake, Aichi, Japan; Hiroko Boda, Department of pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Tetsushi Yoshikawa, Fujita Health University School of Medicine, Toyoake, Aichi, Japan

Background: Fentanyl (FEN) is often used for sedation of extremely premature infants in Japan, but dexmedetomidine (DEX) is rarely used. Some reports said had neuroprotective effects in neonatal animal models. But long-term effect of DEX for extremely preterm infants is not well documented.

Objective: To evaluate long-term effects of DEX on extremely preterm infants, we compared the developmental outcome of extremely preterm infants administered DEX or FEN.

Design/Methods: This was a single-center retrospective observational study. The subjects were infants born between 22 weeks 0 days and 27 weeks 6 days of gestation who were admitted to our hospital between April 2010 and December 2018 and received sedation within 24 hours of birth. Infants who died or had intraventricular hemorrhage, before receiving sedatives, were excluded. We routinely used sedatives for extremely preterm infants and changed the sedative from FEN to DEX in January 2015. FEN was administered at 0.5 μg/kg/h (maximum 2 μg/kg/h), and DEX was administered at 0.3 μg/kg/h (maximum 0.7 μg/kg/h), and both were tapered and discontinued from 72 hours after birth. After matching the two groups by gestational age (GA), a matched pair analysis was performed, and compared long-term prognosis include the Kyoto Scale of Psychological Development (KSPD) DQ < 70 at collected age (CA) 3 years and Wechsler Intelligence Scale for Children - Fourth Edition (WISC4) Full Scale Intelligence Quotient (FSIQ) < 85 at CA 6 years. We used EZR Ver 1.55 to perform univariate analysis using the Mann-Whitney U test and Fisher's exact test.

Results: The subjects were 81 cases, and 15 cases were excluded. FEN group and DEX group were examined with 33 cases each. The median GA were 25 and 26 weeks, in DEX and FEN group respectively, which was smaller in the DEX group (p=0.036). Other perinatal factors were not significantly different. In the FEN group (25 cases) and the DEX group (25 cases) matched for GA, the collected KSDQ < 70 at CA 3 years (FEN 7/19, DEX 5/22), and WISC4 FSIQ < 85 at CA 6 years (FEN 13/20, DEX 8/21) showed no difference.

Conclusion(s): There was no significant difference in long-term developmental prognosis between DEX and FEN. The limitations included different treatment periods between two groups, the degree of sedation was not objectively evaluated, and the small number of cases might prevent the detection of statistically significant differences. DEX might have the potential to be used as a sedative for extremely preterm infants as FEN, but further investigation is needed.