الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: The evidence of routine use of sedatives in mechanically ventilated preterm infants is not established because of adverse effects of commonly used drugs. Dexmeditomedine (DEX) is an emerging alternative. The aim of the work: The aim of our study is to evaluate the effects of DEX use during MV of preterm neonates on the time to first elective extubation, oxygen supplementation and total MV duration. Type of study: Double blind randomized controlled trial. Materials and Methods: This study was conducted on forty preterm infants (≤32weeks) of gestation who required mechanical ventilation during the first five days of life. They were randomly assigned to receive DEX (0.1 mcg/kg/hour) during the first five days or placebo. Time to first extubation was our primary outcome and secondary outcomes were plasma KL-6 at 7th day, Bronchopulmonary dysplasia (BPD), total duration of mechanical ventilation, total duration of oxygen supplementation, need for post natal steroid, pain score, necrotizing enterocolitis (NEC), intra-ventricular hemorrhage (IVH),patent ductus arteriousus (PDA), need for positive inotropes, retinopathy of prematurity (ROP) requiring intervention, days to reach 100ml/kg enteral feeds, adverse effects of DEX and mortality. Results: In our study, DEX use was associated with earlier extubation of mechanically ventilated preterm infants (p value =0.001) compared to placebo. Durations of respiratory support and mechanical ventilation were significantly shorter in DEX group compared to placebo. DEX therapy was associated with lower level of serum KL-6 and EDIN pain score compared to placebo. Patients in DEX group have less need to fentanyl dosing, low incidence of sepsis and IVH. There was no significant difference between groups regarding other secondary outcomes. There is no significant difference between groups regarding side effects. Conclusion: We concluded that DEX use, at a sedative dosage regimen, in mechanically ventilated preterm infants has short term respiratory benefits including (early extubation, short durations of MV and oxygen supplementation with lower KL-6 levels). Furthermore, DEX use is associated with lower IVH and sepsis compared to placebo. Alongside, use of DEX is well tolerated with no reported serious side effects. Recommendations: A larger prospective trial upon appropriately powered sample size and long term follow up should be conducted to definitively address the safety and efficacy of DEX administration for preterm infants.