Objective:

To compare the efficacy and safety of intranasal dexmedetomidine and oral chloral hydrate for sedation in infants under 3 months with congenital heart disease (CHD) and to identify risk factors influencing sedation success.

Approach:

• Study Design: Retrospective analysis of infants with CHD aged under 3 months who underwent outpatient sedation for transthoracic echocardiography (TTE) from January 2023 to January 2024.
• Sedation Administration: Infants received either intranasal dexmedetomidine (2 μg/kg) or oral chloral hydrate (50 mg/kg).
• Data Collection: Collected data included heart rate (HR), pulse oxygen saturation (SpO2), sedation onset time, discharge time, and adverse reactions.
• Outcome Measures: Primary outcome was initial sedation success rate; secondary outcome was identification of risk factors affecting sedation success.

Key Findings:

• Initial sedation success rate was higher in the dexmedetomidine group compared to the chloral hydrate group.
• Sedation onset time and discharge time were shorter in the dexmedetomidine group.
• Decline in heart rate was greater in the dexmedetomidine group.
• No severe adverse reactions were reported.
• Low body weight and prolonged fasting time were identified as independent risk factors affecting sedation success.

Interpretation:

Intranasal dexmedetomidine at 2 μg/kg is associated with higher sedation success rates without increasing severe adverse events in infants with CHD under 3 months.

Limitations:

• Retrospective design may introduce selection bias.
• Single-center study limits generalizability.

Conclusion:

Intranasal dexmedetomidine is associated with higher sedation success rates compared to oral chloral hydrate in infants with CHD under 3 months, with specific risk factors influencing sedation success.