Dexmedetomidine and midazolam usage and association with BSRI scores in preterm infants with chronic respiratory failure.

OBJECTIVE: To quantify midazolam (MID) and dexmedetomidine (DEX) exposure in preterm infants with chronic respiratory failure (CRF) due to severe bronchopulmonary dysplasia (sBPD) and assess associations with Behavioral Signs of Respiratory Instability (BSRI) scores. STUDY DESIGN: Infants born <32 weeks' gestation with sBPD requiring tracheostomy and chronic ventilation were included. Daily MID and DEX exposure was quantified from NICU admission until discharge, death, or transfer. Multivariable mixed-effects models evaluated associations between medication exposure and weekly BSRI scores, adjusting for selected confounders. RESULTS: Among 40 infants (median NICU stay: 202 days), median exposures were 4.4 weeks for DEX and 2 weeks for MID, with peak doses surrounding tracheostomy. Medication exposure was not independently associated with BSRI scores. Higher respiratory severity scores correlated with increased medication doses. CONCLUSION: Neurosedative medication dosing correlated with disease severity. These findings highlight the need to optimize dosing strategies and neurodevelopmental outcomes in this vulnerable population.

VIVO Weill Cornell Medical College