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Comparison of Low and High Dose Clonidine for Infants Admitted to the Neonatal Intensive Care Unit
Jacob Kelner1,2, Clare Riotte2,3, Ursula Marquis4
1Division of Neonatology (JK, SL), Connecticut Children's, Hartford, CT.
Objective:
This study compares the efficacy of starting with low-dose vs high-dose enteral clonidine for the treatment of pain, agitation, and opioid withdrawal in high-risk infants admitted to the neonatal intensive care unit (NICU).
Methods:
This was a retrospective chart review study of infants admitted to a level IV NICU between September 2014 and December 2022 who were started on enteral clonidine before 50 weeks post-menstrual age (PMA) for pain, agitation, or opioid withdrawal. Data were collected over the first 30 days of clonidine treatment. Infants started on low-dose (LDC: <4 mcg/kg/day) and high-dose clonidine (HDC: ≥4 mcg/kg/day) were compared using SPSS V29.0 (IBM) for statistical analyses.
Results:
Ninety-five infants met the inclusion criteria; 41 received LDC, and 54 received HDC. There were no statistically significant differences in any demographic parameter between the groups before starting clonidine. There was no difference in reduction in Neonatal-Pain, Agitation, and Sedation Scale (N-PASS) scores during the 30-day treatment period, despite the LDC group having a lower maximum clonidine dose (4 vs 8 mcg/kg/day, p ≤ 0.01) than the HDC group.
Conclusion:
Our observational study suggests that starting with LDC may be as effective as HDC in treating pain, agitation, and opioid withdrawal in infants admitted to the NICU.
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