Analgesia and sedation trends in a level IV NICU, 2014–2024: Opioid and dexmedetomidine use

OBJECTIVE: Examine 11-year trends in opioid and sedative exposure and dosing practices in a level IV neonatal intensive care unit (NICU). METHODS: This retrospective cohort study included NICU admissions from 2014 to 2024 that received at least one opioid or sedative. Temporal changes in patient characteristics, exposure patterns, continuous infusion regimen composition, and morphine and dexmedetomidine infusion rates were evaluated across three epochs (2014-2017, 2018-2021, 2022-2024). RESULTS: Of 2055 admissions, 1060 (51.6%) encounters were analyzed. Infants admitted in later years were more premature with greater morbidity. Dexmedetomidine continuous infusion use increased fivefold (7.9% to 44.1%; p < 0.001), while morphine infusion use also increased (36.7% to 50.4%; p = 0.0021). Morphine plus dexmedetomidine became the most common continuous infusion regimen by 2022-2024 (28.7%), with higher infusion rates in combination therapy than in monotherapy. CONCLUSION: NICU sedation strategies shifted from morphine monotherapy toward combination therapy with dexmedetomidine. Standardized, outcome-oriented guidelines and multicenter studies are needed.