Efficacy Neonates receiving mechanical ventilation

A single RCT [2] enrolling 112 term newborn infants on mechanical ventilation on fentanyl and midazolam administered clonidine 1 µg/kg/hour or placebo on day 4 after intubation. No differences in mortality [RR 0.69, 95% CI 0.12 to 3.98], duration of mechanical ventilation (7.1 days versus 5.8 days, P = 0.07) or duration of stay in the intensive care unit were reported. Sedation scale values (COMFORT) and analgesia scores (Hartwig) during the first 72 hours of infusion were lower in the clonidine than the placebo group. Clonidine 1 µg/kg/hour in ventilated newborns reduced fentanyl and midazolam demand with deeper levels of analgesia and sedation without substantial side effects. This was not demonstrated in older infants, possibly due to lower clonidine serum levels. Evidence is insufficient to show the efficacy and safety of clonidine for sedation and analgesia in term and preterm newborn infants receiving mechanical ventilation. [8] [LOE II GOR D]

There are no trials comparing clonidine versus dexmedetomidine in paediatric patients. A systematic review of dexmedetomidine use in paediatric patients found dexmedetomidine was associated with similar sedation scores to midazolam, a reduction in opioid use with use of a higher dose dexmedetomidine 0.5 μg/kg/hour but not 0.25 μg/kg/hour infusion, and reduced duration of mechanical ventilation compared to paediatric patients treated with midazolam and fentanyl. [9]