Clonidine for sedation in infants during therapeutic hypothermia with neonatal encephalopathy: pilot study

OBJECTIVE: To determine a safe dose of clonidine (CLON) to be used in infants with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). STUDY DESIGN: A pilot prospective study was performed to determine the effect of CLON on autonomic parameters, the pharmacokinetics (PK) of CLON, and the amount of morphine (MOR) given “as needed” for shivering and agitation in a cohort of infants (n=12) with HIE undergoing TH compared to a historical control group (n=28). RESULTS: The CLON group received less “as needed” MOR than the MOR-only group for agitation/shivering (p < 0.001), and the CLON vs MOR-only group spent 92% vs 79% of cooling time at the target core body temperature (CBT; p = 0.03, CLON vs MOR). CONCLUSIONS: Intravenous CLON (1mcg/kg Q8h) is well tolerated in infants treated with TH for HIE. CLON stabilizes CBT in the ideal range during cooling which may be optimal for neuroprotection.