Use of Dexmedetomidine in Neonates With Open Chest Post Cardiac Surgery

Monday, March 23, 2026

2:30 PM - 3:30 PM Central Time

Location: Connections Central - RST 08

Thomas Fischer, n/a (he/him/his)

Florida

Disclosure(s): No relevant financial relationship(s) to disclose.
AK

Allie Kellner, n/a

Medical Student
University of Florida College of Medicine

Disclosure information not submitted.
BK

Brian Kelly, PharmD, BCPS, BCPPS

Clinical Pharmacy Specialist
University of Florida

Disclosure information not submitted.
DL

Dalia Lopez-Colon, PhD

Clinical Research Coordinator
UF Health Shands Childrens Hospital

Disclosure information not submitted.
DN

Dan Neal, MS

Director of Analytics and Biostatistical Consultant
University of Florida

Disclosure information not submitted.
HH

Hazel Hutchinson, n/a

Administrative Assistant
UF Health Shands Congenital Heart Center

Disclosure information not submitted.
JJ

Jeffrey Jacobs, MD, FACS, FACC, FCCP

Professor of Surgery and Pediatrics
UF Health Shands Congenital Heart Center

Disclosure information not submitted.
MB

Mark Bleiweis, MD

William G. Lassiter Jr. and Aneice R. Lassiter Professor and Director, UF Congenital Heart Center
UF Health Congenital Heart Center

Disclosure information not submitted.
JP

Joseph Philip, MD

Associate Professor and Medical Director of the Pediatric Cardiac Intensive Care Unit
UF Health Shands Childrens Hospital

Disclosure information not submitted.

Introduction: Traditional agents for sedation and analgesia have detrimental effects on long-term central nervous system development in neonates, whereas recent literature has shown comparative neuroprotective effects with dexmedetomidine (dex). Additionally, cardiac surgical neonates have higher risks of post-operative complications and longer stays. Our aim is to demonstrate the safety of the use of dex in neonates needing open chest post cardiopulmonary bypass (CPB).

Methods: A retrospective chart review was conducted on 242 neonates treated with open chest post CPB at the authors institution between January 1, 2012 and December 31, 2023. Patients were divided into three groups based on the median daily max dose of dex administered in the first seven days postoperatively: Group 1= no dex (NP)(n=33), Group 2= normal dex (ND) 0.01-0.70 mcg/kg/hr (n=136), Group 3= high dex (HD) 0.71-1.20 mcg/kg/hr (n=73).

Results: The median total days of mechanical ventilation decreased from 5.2 in the NP group to 4.3 in the HD group (p=.007). Although compared to both ND (p < 0.0001) and HD (p < 0.0001), NP patients were more likely to be transitioned to High Flow Nasal cannula, and less likely to receive Non-invasive ventilation. The Median Max Infusion dose of Fentanyl in the first 7 days Post-Op decreased from 0.75 mcg/kg/hr in NP to 0.5 in ND (p=0.007). 30.3% of patients in the NP group received Midazolam compared to 11% (ND; p=0.001) and 6.8% (HD; p=0.003). 37% of patients in the HD group experienced JET compared to 15.2% in the NP group (p=0.024). Only 10% of NP patients required pacing for relative bradycardia, versus 33.3% of ND (p=0.013) and 33.3% of HD (p=0.015).

Conclusions: The use of dex was associated with a trend of decreased days of mechanical ventilation. While patients on dex were more likely to be transitioned to non-invasive ventilation, over HFNC, NC or room air, this is a preferred outcome over continued mechanical ventilation. Opiate infusions and benzodiazepines were decreased with the use of dex infusions. Patients on dex were more likely to require pacing for post op relative bradycardia, a known side effect of dex. One clinical indication for an increased dose of dex is JET, where its likely use as part of the therapy may explain the link between HD dex and increased rates of post-operative JET.