Clonidine for sedation in infants during therapeutic hypothermia with neonatal encephalopathy: pilot study

• Published in: Journal of perinatology Vol. 42; no. 3; pp. 319 - 327
• Main Authors: Gauda, Estelle B., Chavez-Valdez, Raul, Northington, Frances J., Lee, Carlton K. K., Rudek, Michelle A., Guglieri-Lopez, Beatriz, Ivaturi, Vijay
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-03-2022; Nature Publishing Group
• Subjects: Agitation; Autonomic nervous system; Body temperature; Brain damage; Clonidine; Clonidine - therapeutic use; Cooling; Encephalopathy; Humans; Hypothermia; Hypothermia, Induced; Hypoxia; Hypoxia-Ischemia, Brain - therapy; Infant; Infant, Newborn; Infant, Newborn, Diseases - therapy; Infants; Intravenous administration; Ischemia; Medicine; Medicine & Public Health; Morphine; Neonates; Neuroprotection; Newborn babies; Pediatric Surgery; Pediatrics; Pharmacokinetics; Pilot Projects; Prospective Studies; Shivering
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-021-01151-1

Objective
To determine a safe dose of clonidine (CLON) to be used in infants with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH).
Study design
A pilot prospective study was performed to determine the effect of CLON on autonomic parameters, the pharmacokinetics (PK) of CLON, and the amount of morphine (MOR) given “as needed” for shivering and agitation in a cohort of infants (
n
 = 12) with HIE undergoing TH compared to a historical control group (
n
 = 28).
Results
The CLON group received less “as needed” MOR than the MOR-only group for agitation/shivering (
p
 < 0.001), and the CLON vs. MOR-only group spent 92% vs. 79% of cooling time at the target core body temperature (CBT;
p
 = 0.03, CLON vs. MOR).
Conclusions
Intravenous CLON (1 mcg/kg Q8h) is well tolerated in infants treated with TH for HIE. CLON stabilizes CBT in the ideal range during cooling, which may be optimal for neuroprotection.