Analysis of the Impact of Dexmedetomidine Use in Very Preterm Infants on Long-Term Neurodevelopmental Outcomes

Prolonged sedation in premature infants often involves opioids and benzodiazepines, which can cause adverse effects and worse neurodevelopmental outcomes. Dexmedetomidine has emerged as a safer alternative with fewer side effects, but its long-term neurodevelopmental impact on very preterm infants remains unclear. Further research is needed to understand its effects on this vulnerable population.

The primary objective is to compare the neurodevelopmental outcomes of premature infants who received and did not receive dexmedetomidine infusions while intubated. The secondary objective is to compare the rate of unplanned extubations in these groups.

This was a retrospective cohort study deemed Institutional Review Board (IRB)-exempted by the New York University (NYU) IRB. The study population (n = 15) with a matched control cohort (n = 15) includes infants born under 32 weeks gestation or weighing less than 1,500 g who were intubated during their hospitalization and followed up at our high-risk follow-up program. Patients excluded from the study include those who did not survive to discharge, those lost to follow-up, or those with major congenital anomalies. The patient chart was reviewed for data on maternal characteristics and details from the infant's neonatal intensive care unit (NICU) admission. Data from follow-up visits at six months to two years of life included the Bayley Scales of Infant and Toddler Development, Fourth Edition (BSID-IV) scores. Data were analyzed using Mann-Whitney U testing and Fisher's exact testing.

There was no statistically significant difference (p = 0.373) in BSID-IV scores between the two groups. The overall number of unplanned extubations was not different between the two groups. When assessing unplanned extubations per intubation day, there was a trend toward fewer unplanned extubations in the dexmedetomidine group.

This study suggests that dexmedetomidine may be a safe and effective alternative to traditional sedatives for extremely premature infants, with no observed adverse effects on long-term neurodevelopmental outcomes and potential benefits in reducing extubation-related complications. However, larger, multi-center prospective studies are needed to confirm these findings and inform clinical practice.