Location
Philadelphia, PA
Start Date
30-4-2025 1:00 PM
End Date
30-4-2025 4:00 PM
Description
Introduction
Newborns admitted to neonatal intensive care units (NICUs) often require sedation and analgesia due to critical illness and invasive procedures. Alternatives to narcotics are being used in clinical practice due to improved side effect profiles and decreased risk of dependence. Dexmedetomidine (Precedex), an α₂-adrenergic agonist, and ketamine, an NMDA antagonist, have emerged as attractive alternatives, yet there are limited data on their use in NICUs.
Objective
To assess utilization of dexmedetomidine and ketamine in a large cohort of newborns admitted to US NICUs over time.
Methods
Retrospective cohort study including newborns admitted to a US NICU from 2009-2023 included in the Premier database. We assessed proportions of newborns exposed to each drug overall and by birthweight (BW). We assessed the median first day of exposure and median total days of exposure and assessed visual trends in use over time.
Results
There were 1,721,819 newborns admitted to 818 NICUs from 2009 to 2023. Of these, 8000 (0.5%) received dexmedetomidine and 3515 (0.1%) received ketamine.
For dexmedetomidine, median (IQR) first day of exposure was day 6 (2,27) after birth and total days of exposure was 4 (1,10). Dexmedetomidine use was highest among infants with BW < 500g (4.5% exposed), who received median (IQR) 7 days (2,20). Overall annual proportion of dexmedetomidine exposure increased from 2009 (0.04%) to 2023 (1.30%), with the greatest increase occurring in infants with BW < 500 g (0.38% to 18.29%).
For ketamine, median (IQR) first day of exposure was day 18 after birth and total days of exposure was 1 (1,2). Ketamine use was highest among infants with BW < 1000g (1.5% exposed), though the first day of exposure for this group was considerably later during the second or third month. Overall annual proportion of ketamine usage increased from 2009 (0.16%) to 2023 (0.27%) but showed an inconsistent pattern. No appreciable trend of usage was evidenced within BW groups >500 g.
Discussion
The current study showed dexmedetomidine and ketamine use increased among newborns admitted to US NICUs from 2009 to 2023.
Infants born < 1000g, particularly those < 500g, had the highest exposure rates for both drugs. Dexmedetomidine was prescribed for about a week and used around one month of age for the smallest infants; we speculate this is due to prolonged mechanical ventilation and ongoing clinical instability. Ketamine was typically prescribed for one day and was used earlier for bigger infants and much later in hospitalization for the smallest infants; we speculate this is due to use for short interventions such as procedures.
Given the increasing use of these drugs in NICUs despite a paucity of data on safety and efficacy, further research is needed to guide optimal use in critically ill newborns, particularly those born weighing < 1000g. These data on current utilization patterns can inform prospective safety and comparative effectiveness studies.
Embargo Period
5-29-2025
Included in
Utilization of dexmedetomidine and ketamine in neonatal intensive care units across the US from 2009 to 2023
Philadelphia, PA
Introduction
Newborns admitted to neonatal intensive care units (NICUs) often require sedation and analgesia due to critical illness and invasive procedures. Alternatives to narcotics are being used in clinical practice due to improved side effect profiles and decreased risk of dependence. Dexmedetomidine (Precedex), an α₂-adrenergic agonist, and ketamine, an NMDA antagonist, have emerged as attractive alternatives, yet there are limited data on their use in NICUs.
Objective
To assess utilization of dexmedetomidine and ketamine in a large cohort of newborns admitted to US NICUs over time.
Methods
Retrospective cohort study including newborns admitted to a US NICU from 2009-2023 included in the Premier database. We assessed proportions of newborns exposed to each drug overall and by birthweight (BW). We assessed the median first day of exposure and median total days of exposure and assessed visual trends in use over time.
Results
There were 1,721,819 newborns admitted to 818 NICUs from 2009 to 2023. Of these, 8000 (0.5%) received dexmedetomidine and 3515 (0.1%) received ketamine.
For dexmedetomidine, median (IQR) first day of exposure was day 6 (2,27) after birth and total days of exposure was 4 (1,10). Dexmedetomidine use was highest among infants with BW < 500g (4.5% exposed), who received median (IQR) 7 days (2,20). Overall annual proportion of dexmedetomidine exposure increased from 2009 (0.04%) to 2023 (1.30%), with the greatest increase occurring in infants with BW < 500 g (0.38% to 18.29%).
For ketamine, median (IQR) first day of exposure was day 18 after birth and total days of exposure was 1 (1,2). Ketamine use was highest among infants with BW < 1000g (1.5% exposed), though the first day of exposure for this group was considerably later during the second or third month. Overall annual proportion of ketamine usage increased from 2009 (0.16%) to 2023 (0.27%) but showed an inconsistent pattern. No appreciable trend of usage was evidenced within BW groups >500 g.
Discussion
The current study showed dexmedetomidine and ketamine use increased among newborns admitted to US NICUs from 2009 to 2023.
Infants born < 1000g, particularly those < 500g, had the highest exposure rates for both drugs. Dexmedetomidine was prescribed for about a week and used around one month of age for the smallest infants; we speculate this is due to prolonged mechanical ventilation and ongoing clinical instability. Ketamine was typically prescribed for one day and was used earlier for bigger infants and much later in hospitalization for the smallest infants; we speculate this is due to use for short interventions such as procedures.
Given the increasing use of these drugs in NICUs despite a paucity of data on safety and efficacy, further research is needed to guide optimal use in critically ill newborns, particularly those born weighing < 1000g. These data on current utilization patterns can inform prospective safety and comparative effectiveness studies.