195 - Comparison of Low and High Dose Clonidine Use for Infants Admitted to the Neonatal Intensive Care Unit

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 195
Publication Number: 195.333

Jacob Kelner, Connecticut Children's Medical Center, Hartford, CT, United States; Clare Riotte, Connecticut Childrens Medical Center, Hartford, CT, United States; Jessica Askew, Connecticut Children's Medical Center, Granby, CT, United States; Ursula G. Marquis, Connecticut Children's Medical Center, Hartford, CT, United States; Shabnam Lainwala, University of Connecticut School of Medicine, Hartford, CT, United States

Presenting Author(s)

Jacob Kelner, DO (he/him/his)

Fellow
Connecticut Children's Medical Center
Hartford, Connecticut, United States

Background:

In Neonatal Intensive Care Units (NICU), high-risk infants’ pain and agitation is commonly treated with narcotics and sedatives. Due to concerns for long term outcomes in infants exposed to these medications, there is a need for alternate medications. Recently, clonidine is being used to treat pain, agitation and narcotic withdrawal in high-risk infants. However, there is limited research on dosage and efficacy of clonidine in this population.

Objective:

To compare dosage, efficacy, and adverse effects of low (LDC; < 4 mcg/k/day) and high (HDC; > 4 mcg/k/day) dose clonidine for the treatment of pain, agitation, and narcotic withdrawal in high-risk infants.

Design/Methods:

This was a retrospective study. Infants born between 09/01/2014 and 11/30/2020 and started on clonidine for pain, agitation or narcotic withdrawal while admitted to the NICU were included. Infants with surgery while on clonidine, treated with clonidine for < 48 hr, expired within 30 days of clonidine initiation or had insufficient documentation were excluded. Infant demographics and morbidities, clonidine dosage, associated adverse effects, use of narcotics/sedatives, and Neonatal Pain, Agitation and Sedation Scale (N-PASS) scores during the first 30 days of clonidine treatment were compared using univariate analyses.

Results:

Of 97 infants treated with clonidine, 63 were included: LDC (N=33) and HDC (N=30). No significant difference in demographics and neonatal morbidities were noted between groups. (Table 1) The starting and maximum clonidine doses were significantly different between LDC and HDC groups. (p value < 0.002) Initial N-PASS score and narcotic/sedative medications, reduction in N-PASS score and narcotic/sedative medication use, associated adverse effects and infants on clonidine at day 30 of treatment were not significantly different in the two groups. (Table 2)

Conclusion(s):

Our study showed that low and high dose clonidine have similar efficacy for treatment of pain, agitation and narcotic withdrawal in high-risk infants in the NICU. Clonidine was relatively safe with low adverse effects. A randomized control trial is needed to compare efficacy and safety of low and high dose clonidine use in high-risk infants.