Dexmedetomidine and midazolam usage and association with BSRI scores in preterm infants with chronic respiratory

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John Mascari1, Spencer Millen2, Tanvi Batish2

  • 1Ann & Robert H. Lurie Children's Hospital of Chicago; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. jom4053@med.cornell.edu.

Journal of Perinatology : Official Journal of the California Perinatal Association
|February 23, 2026
PubMed

Insights

This study found that neurosedative medication exposure in preterm infants with severe bronchopulmonary dysplasia did not correlate with respiratory instability signs. However, higher disease severity was linked to increased medication doses.

Area of Science:

  • Neonatal Medicine
  • Pharmacology
  • Respiratory Medicine

Background:

  • Preterm infants with severe bronchopulmonary dysplasia (sBPD) often require prolonged mechanical ventilation and may receive neurosedative medications like midazolam (MID) and dexmedetomidine (DEX).
  • Understanding medication exposure patterns and their relationship with clinical outcomes is crucial for optimizing care in this vulnerable population.

Purpose of the Study:

  • To quantify midazolam (MID) and dexmedetomidine (DEX) exposure in preterm infants with chronic respiratory failure (CRF) due to sBPD.
  • To assess the association between MID and DEX exposure and Behavioral Signs of Respiratory Instability (BSRI) scores.

Main Methods:

  • A cohort of preterm infants (<32 weeks' gestation) with sBPD requiring tracheostomy and chronic ventilation were studied.
  • Daily MID and DEX exposure was tracked from NICU admission. Multivariable mixed-effects models were used to analyze associations with weekly BSRI scores, controlling for confounders.

Main Results:

  • Median DEX exposure was 4.4 weeks and MID exposure was 2 weeks among 40 infants.
  • Peak medication doses were observed around the time of tracheostomy.
  • No independent association was found between medication exposure and BSRI scores; however, higher respiratory severity correlated with increased medication doses.

Conclusions:

  • Neurosedative medication dosing in infants with sBPD appears to correlate with disease severity.
  • These findings suggest a need for optimized dosing strategies to improve both clinical outcomes and neurodevelopmental trajectories in this high-risk group.
Abstract

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