Table 2.

Advantages and disadvantages of available agents for sedation of preterm neonates during mechanical vecntilation.

Agent	Advantages	Disadvantages
Morphine	Increased ventilator synchrony Decreased adrenaline concentrations No impact on incidence of severe IVH, PVL, or death	Tachyphylaxis Hypotension Prolongation of mechanical ventilation Prolongation of time to full enteral feedings Reduced cerebellar growth at high doses
Fentanyl	Decreased adrenaline and cortisol concentrations Less impact on gastrointestinal motility compared to morphine	Rapid tachyphylaxis Prolongation of mechanical ventilation Delayed meconium passage Reduced cerebellar growth at high doses
Midazolam	Decreased sedation scores	Increased severe IVH, PVL, or death Hypotension Myoclonus Frequent delirium Potential for neuroapoptosis and delayed motor development
Dexmedetomidine	Decreased adjunctive sedation compared to fentanyl Decreased incidence of delirium compared to benzodiazepine Minimal respiratory depression Minimal impact on gastrointestinal motility Potential for neuroprotection after PVL, hypoxia–ischemia, or concurrent neurotoxic drug exposure	Potential hypotension

IVH intraventricular hemorrhage, PVL periventricular leukomalacia