The following is a summary of “Oral Clonidine-based Strategy to Reduce Opiate Use during Cooling for Neonatal Encephalopathy: An Observational Study,” published in the June 2024 issue of Pediatrics by Fribance et al.
To evaluate whether an enteral clonidine-based sedation strategy (CLON) during therapeutic hypothermia (TH) for neonates with hypoxic-ischemic encephalopathy (HIE) could reduce opiate usage compared to a morphine-based strategy (MOR) while maintaining similar safety and efficacy profiles.
This single-center observational study, conducted at a level IV neonatal intensive care unit, lasted from January 1, 2017, to October 1, 2021. The study period encompassed the transition from MOR (before April 13, 2020) to CLON (after August 13, 2020) protocols. Neonates undergoing TH for HIE were categorized into MOR and CLON groups. The primary outcome measured was total morphine milligram equivalent (MME) per kg, including rescue doses, while secondary outcomes included the frequency of hemodynamic changes.
Among the 99 neonates studied, 74 received MOR, and 25 received CLON. Baseline characteristics and the requirement for rescue sedatives were similar between groups. The CLON group demonstrated significantly lower total MME/kg and fewer rescue opiate administrations than MOR (p < 0.001). As the duration of TH progressed, fewer CLON-treated neonates required rescue opiates (92% on day 1 to 68% on day 3). MOR-treated neonates received higher cumulative doses of dopamine and more frequently needed additional inotropic support and hydrocortisone for hypotension. The respiratory rate was significantly lower in the MOR group during TH than CLON (p = 0.01).
The CLON sedation protocol appears non-inferior to MOR in terms of perceived efficacy and hemodynamic safety while demonstrating a reduced need for opiates and associated cardiovascular support. These findings suggest that CLON may offer a promising alternative to morphine-based sedation strategies during TH for neonatal HIE, potentially minimizing opiate-related complications without compromising therapeutic efficacy or safety.
Source: sciencedirect.com/science/article/abs/pii/S0022347624002610