{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:41:12Z","timestamp":1790800872484,"version":"4.1.0"},"reference-count":28,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n \n Dexmedetomidine, an \u03b1\n 2<\/jats:sub>\n -adrenergic agonist, is not approved by the Food and Drug Administration for use in premature infants. However, the off-label use of dexmedetomidine in premature infants has increased 50-fold in the past decade. Currently, there are no large studies characterizing dexmedetomidine use in US neonatal intensive care units (NICUs) or comparing the use of dexmedetomidine vs opioids in infants.\n <\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To describe dexmedetomidine use patterns in the NICU and examine the association between dexmedetomidine and opioid use in premature infants.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n A multicenter, observational cohort study was conducted from November 11, 2022, to April 4, 2023. Participants were inborn infants born between 22 weeks, 0 days, and 36 weeks, 6 days, of gestation at 1 of 383 Pediatrix Medical Group NICUs across the US between calendar years 2010 and 2020.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measure<\/jats:title>\n Exposure to medications of interest defined as total days of exposure, timing of use, and changes over time.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 395\u202f122 infants were included in the analysis. Median gestational age was 34 (IQR, 32-35) weeks, and median birth weight was 2040 (IQR, 1606-2440) g. There were 384 infants (0.1% of total; 58.9% male) who received dexmedetomidine. Infants who received dexmedetomidine were born more immature, had lower birth weight, longer length of hospitalization, more opioid exposure, and more days of mechanical ventilation. Dexmedetomidine use increased from 0.003% in 2010 to 0.185% in 2020 (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001 for trend), while overall opioid exposure decreased from 8.5% in 2010 to 7.2% in 2020 (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001 for trend). The median postmenstrual age at first dexmedetomidine exposure was 31 (IQR, 27-36) weeks, and the median postnatal age at first dexmedetomidine exposure was 3 (IQR, 1-35) days. The median duration of dexmedetomidine receipt was 6 (IQR, 2-14) days.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion and Relevance<\/jats:title>\n The findings of this multicenter cohort study of premature infants suggest that dexmedetomidine use increased significantly between 2010 and 2020, while overall opioid exposure decreased. Future studies are required to further examine the short- and long-term effects of dexmedetomidine in premature and critically ill infants.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.41033","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T11:31:05Z","timestamp":1699011065000},"page":"e2341033","source":"Crossref","is-referenced-by-count":34,"title":["Use of Dexmedetomidine and Opioids in Hospitalized Preterm Infants"],"prefix":"10.1001","volume":"6","author":[{"given":"Samantha","family":"Curtis","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Kilpatrick","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Duke University Medical Center, Durham, North Carolina"},{"name":"Duke Clinical Research Institute, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeenia C.","family":"Billimoria","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington School of Medicine, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanecia","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Duke University Medical Center, Durham, North Carolina"},{"name":"Duke Clinical Research Institute, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veeral","family":"Tolia","sequence":"additional","affiliation":[{"name":"Pediatrix Medical Group, Baylor Scott and White Healthcare, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reese","family":"Clark","sequence":"additional","affiliation":[{"name":"MEDNAX Center for Research, Education, Quality and Safety, San Antonio, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel G.","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Duke University Medical Center, Durham, North Carolina"},{"name":"Duke Clinical Research Institute, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai","family":"Puia-Dumitrescu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington School of Medicine, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,11,3]]},"reference":[{"key":"zoi231193r1","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.jpeds.2021.08.075","article-title":"Medication use in the neonatal intensive care unit and changes from 2010 to 2018.","volume":"240","author":"Stark","year":"2022","journal-title":"J Pediatr"},{"issue":"2","key":"zoi231193r2","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1016\/j.jpeds.2013.10.002","article-title":"A phase II\/III, multicenter, safety, efficacy, and pharmacokinetic study of dexmedetomidine in preterm and term neonates.","volume":"164","author":"Chrysostomou","year":"2014","journal-title":"J Pediatr"},{"issue":"5","key":"zoi231193r3","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1177\/1060028018812089","article-title":"Dexmedetomidine use in a tertiary care NICU: a descriptive study.","volume":"53","author":"Dersch-Mills","year":"2019","journal-title":"Ann Pharmacother"},{"issue":"4","key":"zoi231193r4","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1016\/j.clp.2019.08.004","article-title":"Pharmacology of common analgesic and sedative drugs used in the neonatal intensive care unit.","volume":"46","author":"Donato","year":"2019","journal-title":"Clin Perinatol"},{"issue":"2","key":"zoi231193r5","doi-asserted-by":"publisher","first-page":"112","DOI":"10.5863\/1551-6776-20.2.112","article-title":"Characterization of dexmedetomidine dosing and safety in neonates and infants.","volume":"20","author":"Estkowski","year":"2015","journal-title":"J Pediatr Pharmacol Ther"},{"issue":"5","key":"zoi231193r6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-041566","article-title":"Reducing benzodiazepine exposure by instituting a guideline for dexmedetomidine usage in the NICU.","volume":"148","author":"Morton","year":"2021","journal-title":"Pediatrics"},{"issue":"3","key":"zoi231193r7","doi-asserted-by":"publisher","first-page":"252","DOI":"10.5863\/1551-6776-17.3.252","article-title":"Dexmedetomidine versus standard therapy with fentanyl for sedation in mechanically ventilated premature neonates.","volume":"17","author":"O\u2019Mara","year":"2012","journal-title":"J Pediatr Pharmacol Ther"},{"issue":"13","key":"zoi231193r8","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.2146\/ajhp100257","article-title":"Dexmedetomidine for opioid and benzodiazepine withdrawal in pediatric patients.","volume":"68","author":"Oschman","year":"2011","journal-title":"Am J Health Syst Pharm"},{"issue":"8","key":"zoi231193r9","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1097\/PCC.0000000000000200","article-title":"Long-term dexmedetomidine use and safety profile among critically ill children and neonates.","volume":"15","author":"Whalen","year":"2014","journal-title":"Pediatr Crit Care Med"},{"issue":"3","key":"zoi231193r10","doi-asserted-by":"publisher","first-page":"227","DOI":"10.5863\/1551-6776-24.3.227","article-title":"Dexmedetomidine for the management of postoperative pain and sedation in newborns.","volume":"24","author":"Sellas","year":"2019","journal-title":"J Pediatr Pharmacol Ther"},{"issue":"2","key":"zoi231193r11","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1038\/s41390-019-0744-6","article-title":"The influence of pain, agitation, and their management on the immature brain.","volume":"88","author":"McPherson","year":"2020","journal-title":"Pediatr Res"},{"issue":"7","key":"zoi231193r12","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.15998","article-title":"Assessment of 2-year neurodevelopmental outcomes in extremely preterm infants receiving opioids and benzodiazepines.","volume":"4","author":"Puia-Dumitrescu","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"1","key":"zoi231193r13","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.clp.2010.01.016","article-title":"The Pediatrix BabySteps Data Warehouse and the Pediatrix QualitySteps improvement project system\u2014tools for \u201cmeaningful use\u201d in continuous quality improvement.","volume":"37","author":"Spitzer","year":"2010","journal-title":"Clin Perinatol"},{"issue":"1","key":"zoi231193r14","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1007\/s12098-014-1585-2","article-title":"The Pediatrix BabySteps Data Warehouse\u2014a unique national resource for improving outcomes for neonates.","volume":"82","author":"Spitzer","year":"2015","journal-title":"Indian J Pediatr"},{"issue":"4","key":"zoi231193r15","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"issue":"3","key":"zoi231193r16","first-page":"34","article-title":"Intraventricular hemorrhage in term neonates: sources, severity and outcome.","volume":"9","author":"Afsharkhas","year":"2015","journal-title":"Iran J Child Neurol"},{"issue":"4","key":"zoi231193r17","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1016\/j.jpeds.2013.04.053","article-title":"Comparative effectiveness of surfactant preparations in premature infants.","volume":"163","author":"Trembath","year":"2013","journal-title":"J Pediatr"},{"issue":"5","key":"zoi231193r18","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1016\/j.survophthal.2018.04.002","article-title":"Retinopathy of prematurity: a review of risk factors and their clinical significance.","volume":"63","author":"Kim","year":"2018","journal-title":"Surv Ophthalmol"},{"issue":"1","key":"zoi231193r19","doi-asserted-by":"publisher","DOI":"10.1136\/bmjpo-2022-001460","article-title":"Sedation and analgesia from prolonged pain and stress during mechanical ventilation in preterm infants: is dexmedetomidine an alternative to current practice?","volume":"6","author":"Ojha","year":"2022","journal-title":"BMJ Paediatr Open"},{"issue":"4","key":"zoi231193r20","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1007\/s00134-011-2140-5","article-title":"Impact of dexmedetomidine on early extubation in pediatric cardiac surgical patients.","volume":"37","author":"Le","year":"2011","journal-title":"Intensive Care Med"},{"issue":"2","key":"zoi231193r21","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1177\/0194599810391397","article-title":"Dexmedetomidine use in pediatric airway reconstruction.","volume":"144","author":"Silver","year":"2011","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"1","key":"zoi231193r22","doi-asserted-by":"publisher","first-page":"17","DOI":"10.4103\/0970-9185.76610","article-title":"Preliminary experience with dexmedetomidine in neonatal anesthesia.","volume":"27","author":"Dilek","year":"2011","journal-title":"J Anaesthesiol Clin Pharmacol"},{"issue":"5","key":"zoi231193r23","doi-asserted-by":"publisher","DOI":"10.1097\/pq9.0000000000000106","article-title":"Reduction of analgesia duration after tracheostomy during neonatal intensive care: a quality initiative.","volume":"3","author":"Puthoff","year":"2018","journal-title":"Pediatr Qual Saf"},{"issue":"6","key":"zoi231193r24","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1111\/pan.2017.27.issue-6","article-title":"Dexmedetomidine sedation combined with caudal anesthesia for lower abdominal and extremity surgery in ex-preterm and full-term infants.","volume":"27","author":"Waurick","year":"2017","journal-title":"Paediatr Anaesth"},{"issue":"15","key":"zoi231193r25","doi-asserted-by":"publisher","first-page":"2836","DOI":"10.1080\/14767058.2020.1803263","article-title":"An assessment of the impact of dexmedetomidine on opioid use in a neonatal intensive care unit.","volume":"35","author":"Dersch-Mills","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"5","key":"zoi231193r26","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012468.pub2","article-title":"Clonidine for sedation and analgesia for neonates receiving mechanical ventilation.","volume":"5","author":"Romantsik","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"zoi231193r27","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1007\/s40199-019-00266-3","article-title":"Therapeutic approaches for neonatal abstinence syndrome: a systematic review of randomized clinical trials.","volume":"27","author":"Ghazanfarpour","year":"2019","journal-title":"Daru"},{"issue":"2","key":"zoi231193r28","doi-asserted-by":"publisher","first-page":"e383","DOI":"10.1542\/peds.2014-2377","article-title":"Morphine versus clonidine for neonatal abstinence syndrome.","volume":"135","author":"Bada","year":"2015","journal-title":"Pediatrics"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2811321\/curtis_2023_oi_231193_1698176561.48503.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T11:31:08Z","timestamp":1699011068000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2811321"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,3]]},"references-count":28,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.41033","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,3]]}}}