2026 Eastern States Conference

Authors: Kayla Bey, PharmD; Anthony Vecchione, PharmD; Francesca Mernick, PharmD 

Background: 
Dexmedetomidine is a centrally acting alpha-2 agonist used for light to moderate sedation, with a lower risk of respiratory depression. Dexmedetomidine has also been shown to affect thermoregulation via central alpha-2 receptors. Adult studies have shown an association between dexmedetomidine and hyperthermia, with risk factors such as obesity and open-heart surgery. Pediatric data are limited, with one recent single-center study reporting fever incidence of 8.6% in PICU/NICU patients receiving dexmedetomidine. Understanding the incidence of fever in a broader pediatric cohort is important, as fever in critically ill children may trigger unnecessary infectious workups and antibiotic exposure. 

Learning Objective: 
Build upon the limited data on the incidence of fever in pediatric patients in the pediatric intensive care unit (PICU) receiving dexmedetomidine in a large academic medical center

Methods: 
This retrospective chart review included pediatric patients admitted to the PICU from April 1, 2022 to October 1, 2025 who received ≥6 hours of dexmedetomidine. Patients with fever prior to initiation or conditions affecting thermoregulation were excluded. The primary outcome was incidence of fever (≥38°C). Secondary outcomes included dexmedetomidine dosing and duration, time to fever onset, infectious workup, antibiotic initiation, and acetaminophen and steroid use. Continuous variables were compared using Wilcoxon rank-sum test and categorical variables using chi-square test.

Results:
Of 191 included patients, 36 (18.8%) developed fever. Median time to fever onset was 41 hours. Patients with fever had higher maximum dexmedetomidine rates (1.6 vs 1.0 mcg/kg/hr, p<0.001) and longer duration of therapy (144 vs 24 hours, p<0.001). No differences were observed in age, weight, or BMI. Among febrile patients, 27.8% underwent infectious workup and received antibiotics.

Conclusion:
Dexmedetomidine-associated fever occurred in nearly one-fifth of pediatric patients and was associated with higher doses and longer durations of therapy. Recognition of this association may reduce unnecessary infectious evaluations and antimicrobial use.