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• W4313232736 abstract "Introduction: Therapeutic hypothermia (TH) to core temperature of 33-34°C is standard of care to treat hypoxic ischemic encephalopathy (HIE) in neonates. TH efficacy is lost with inadequate control of shivering and agitation. Clonidine is a central α2-adrenergic receptor agonist that provides sedation and regulates body temperature without inducing respiratory depression. The purpose of this study was to evaluate the perceived efficacy and safety of using a clonidine-based versus morphine-based sedation and shivering management strategy during TH. Methods: This was a single-center, retrospective cohort study conducted at a tertiary academic level IV neonatal intensive care unit from January 1, 2017 to October 1, 2021, with a washout period from April 13, 2020 to August 12, 2020. Patients were included if they were diagnosed with HIE and underwent TH. The institutional protocol utilized a morphine-based regimen for shivering and agitation prior to April 2020, and was modified to utilize a clonidine-based regimen afterwards, thus patients were grouped into morphine and clonidine epochs. Protocol adherence and the frequency of additional sedating medication use were compared between the two groups. Results: A total of 99 patients were included for analysis, with 74 patients in the morphine epoch and 25 patients in the clonidine epoch. Observed dosing of the primary shivering relief agent per day of TH was consistent with institutional recommendations. The rate of initiation of any sedative continuous infusion was similar between the morphine and clonidine epoch (21.6% vs 20%, p = 0.44). The rate of initiation of fentanyl infusions and cumulative dosing of fentanyl per day of cooling were similar between epochs, but cumulative fentanyl dosing was higher on day 2 of TH (median 55.6 vs 2.0 mcg/kg/day, p = 0.05). Opioid use, as measured in morphine milligram equivalents (MME) per kilogram, was significantly higher in the morphine epoch (median 2.0 vs 1.2 MME/kg, p < 0.0001) but similar in PRN doses (median 1.0 vs 1.6 MME/kg, p = 0.67). Conclusions: Morphine-based protocols for sedation and shivering control during TH resulted in greater cumulative exposure to opiates with unclear long-term consequences. Clonidine, at the proposed dosages, reduced the use of additional opiates, while maintaining effectiveness." @default.
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• W4313232736 date "2022-12-15" @default.
• W4313232736 modified "2023-09-27" @default.
• W4313232736 title "667: CLONIDINE TO CONTROL SHIVERING DURING THERAPEUTIC HYPOTHERMIA TO TREAT NEONATAL ENCEPHALOPATHY" @default.
• W4313232736 doi "https://doi.org/10.1097/01.ccm.0000908400.54564.76" @default.
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