Evidence map›Paper›PMID 38889855›Full record

Observational studyThe Journal of pediatrics2024

Oral Clonidine-Based Strategy to Reduce Opiate Use During Cooling for Neonatal Encephalopathy: An Observational Study.

Haley Fribance, Caroline Liang, Carlton K K Lee, Khyzer Aziz, Charlamaine Parkinson, Estelle B Gauda, Frances J Northington, Bethany S Chalk, Raul Chavez-Valdez

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in The Journal of pediatrics, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Haley FribanceDepartment of Pharmacy, Johns Hopkins Bayview Medical Center, Baltimore, MD.
Caroline LiangDepartment of Pharmacy, Johns Hopkins Bayview Medical Center, Baltimore, MD.
Carlton K K LeeDepartment of Pediatric Pharmacy, Johns Hopkins Medical Institution, Johns Hopkins Hospital, Baltimore, MD; Department of Pediatrics, Johns Hopkins University - School of Medicine, Baltimore, MD.
Khyzer AzizDepartment of Pediatrics, Johns Hopkins University - School of Medicine, Baltimore, MD; Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, MD; Department of Pediatrics, Neonatology, Neuroscience Intensive Care Nursery Program, Johns Hopkins University, School of Medicine, Baltimore, MD.
Charlamaine ParkinsonDivision of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, MD; Department of Pediatrics, Neonatology, Neuroscience Intensive Care Nursery Program, Johns Hopkins University, School of Medicine, Baltimore, MD.
Estelle B GaudaDepartment of Pediatrics, Division of Neonatology, University of Toronto, Toronto, ON, Canada.
Frances J NorthingtonDepartment of Pediatrics, Johns Hopkins University - School of Medicine, Baltimore, MD; Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, MD; Department of Pediatrics, Neonatology, Neuroscience Intensive Care Nursery Program, Johns Hopkins University, School of Medicine, Baltimore, MD.
Bethany S ChalkDepartment of Pediatric Pharmacy, Johns Hopkins Medical Institution, Johns Hopkins Hospital, Baltimore, MD.
Raul Chavez-ValdezDepartment of Pediatrics, Johns Hopkins University - School of Medicine, Baltimore, MD; Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, MD; Department of Pediatrics, Neonatology, Neuroscience Intensive Care Nursery Program, Johns Hopkins University, School of Medicine, Baltimore, MD. Electronic address: rchavez2@jhmi.edu.

Funding

Advanced therapeutic hypothermia efficacy network modeling in neonatal HIER01HD110091 · NICHD · JOHNS HOPKINS UNIVERSITY · PI EVERETT, ALLEN D, NORTHINGTON, FRANCES J · 2022 to 2025
$2.7M
Precision Medicine for Neonatal Hypoxic-Ischemic Encephalopathy: Combined Neuroimaging Clinical Approach to Link Phenotypes to PrognosisR01NS126549 · NINDS · JOHNS HOPKINS UNIVERSITY · PI Kenichi Oishi · 2022 to 2026
$2.0M
Injury of Hippocampal Interneurons following Neonatal Hypoxia-Ischemia and Therapeutic HypothermiaK08NS096115 · NINDS · JOHNS HOPKINS UNIVERSITY · PI CHAVEZ-VALDEZ, RAUL · 2017 to 2021
$1.2M
Cholinergic neuron degeneration after HI: New target for delayed therapy of neonatal HI to improve Learning and Memory DeficitsR21NS123814 · NINDS · JOHNS HOPKINS UNIVERSITY · PI NORTHINGTON, FRANCES J · 2022 to 2023
$450k
NICHD NIH HHS R01 HD110091NINDS NIH HHS K08 NS096115NINDS NIH HHS R01 NS126549NINDS NIH HHS R21 NS123814
6 · The paper itself

Abstract

objectiveTo determine whether an enteral, clonidine-based sedation strategy (CLON) during therapeutic hypothermia (TH) for hypoxic-ischemic encephalopathy would decrease opiate use while maintaining similar short-term safety and efficacy profiles to a morphine-based strategy (MOR). STUDY

designThis was a single-center, observational study conducted at a level IV neonatal intensive care unit from January 1, 2017, to October 1, 2021. From April 13, 2020, to August 13, 2020, we transitioned from MOR to CLON. Thus, patients receiving TH for hypoxic-ischemic encephalopathy were grouped to MOR (before April 13, 2020) and CLON (after August 13, 2020). We calculated the total and rescue morphine milligram equivalent/kg (primary outcome) and frequency of hemodynamic changes (secondary outcome) for both groups.

resultsThe MOR and CLON groups (74 and 25 neonates, respectively) had similar baseline characteristics and need for rescue sedative intravenous infusion (21.6% MOR and 20% CLON). Both morphine milligram equivalent/kg and need for rescue opiates (combined bolus and infusions) were greater in MOR than CLON (P < .001). As days in TH advanced, a lower percentage of patients receiving CLON needed rescue opiates (92% on day 1 to 68% on day 3). Patients receiving MOR received a greater cumulative dose of dopamine and more frequently required a second inotrope and hydrocortisone for hypotension. MOR had a lower respiratory rate during TH (P = .01 vs CLON).

conclusionsOur CLON protocol is noninferior to MOR, maintaining perceived effectiveness and hemodynamic safety, with an apparently reduced need for opiates and inotropes.

Indexed as

Analgesics, OpioidClonidineHypothermia, InducedHypoxia-Ischemia, BrainAdministration, OralFemaleHumansHypnotics and SedativesInfant, NewbornIntensive Care Units, NeonatalMaleMorphineAnalgesics, OpioidClonidineHypnotics and SedativesMorphinehypoxic-ischemic encephalopathysedationtherapeutic hypothermiaα2-adrenergic agonist

Identifiers

PMID38889855
PMCPMC11415280

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.