Sedation-Analgesia Management in Neonates with Hypoxic-Ischemic Encephalopathy under Therapeutic Hypothermia: Feedback from a Local Study on 51 Patients.

Abstract

Objective: The objective of this study is to explore real-world practices in managing sedation-analgesia in a population of neonates with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia.

Study design: Retrospective data from neonates admitted with hypoxic-ischemic encephalopathy to the neonatal intensive care unit of Lille University Hospital were collected, between December 31, 2018, and July 15, 2022. Drug and dosage of sedation-analgesia during the 96 hours following therapeutic hypothermia initiation were collected. Neonates were divided into four subgroups for principal component analysis, according to neurological examination at discharge: death, severe sequelae, moderate sequelae, no sequelae.

Results: Neonates with a favorable outcome were exposed to higher cumulative doses. They were more likely to be exposed to polypharmacy, midazolam, and dexmedetomidine, and increasing doses of these. Daily doses of opioids did not vary significantly. Newborns with acute renal failure had lower cumulative doses. There was no significant difference between newborns with and without hepatic cytolysis.

Conclusion: Practice assessments highlight heterogeneity regarding sedation-analgesia, especially within patient groups. Findings indicate that sedation-analgesia is not reassessed as often as it should be to account for specific pharmacokinetic parameters and the physiologic course of recovery.

Key points: · Although sedation-analgesia is considered standard of care during therapeutic hypothermia, its use may be iatrogenic; therefore, we evaluated our practices to move toward optimized, personalized management.. · Neonates with a favorable outcome were more likely to have been exposed to a higher cumulative dose; increasing doses; polypharmacy; midazolam; and dexmedetomidine.. · Findings indicate that sedation-analgesia is not reassessed as often as it should be..