Abstract Rationale Ketamine is a commonly used sedative in children, particularly as an adjunct when target sedation depth is unmet. Infants with severe bronchopulmonary dysplasia (sBPD; grades 2-3) often require multiple sedatives to achieve adequate sedation and may benefit from this medication, but its use in this population is not well described in the literature. The objective of this study was to characterize recent temporal trends in the use of ketamine infusion in preterm infants with sBPD and identify patient and clinical characteristics associated with its use. Methods We conducted a 15-year (2010-2024) retrospective cohort study of infants with sBPD using data from the Children’s Hospital Association Pediatric Health Information System (PHIS). We included infants with any exposure to ketamine during the study period (from 36 weeks PMA to discharge or 18 months of age). A sub-analysis was performed for infants who were on a ketamine infusion for ≥2 consecutive days, in order to capture those who received the medication for indications beyond procedural sedation. Pulmonary hypertension (PH) was defined as exposure to a pulmonary vasodilator beyond 36 weeks PMA. Multivariable logistic regression was used to determine the association between ketamine infusion and patient-level characteristics. Results We identified 8,888 extremely preterm infants with sBPD with a median GA of 25 weeks (IQR 24-26). Of these, 112 (1.3%) received a ketamine infusion at a median PMA of 53 weeks (IQR 46-60) over a median duration of 7 days (IQR 3-14). 814 infants (9.2%) were exposed to ketamine at any time. Ketamine infusions increased over time, particularly from 2020-2024. A significant association between time period and ketamine infusion remained after multivariable adjustment, aOR (95% CI) 3.30 (1.30, 8.88) for 2020-24 vs 2010-14; p 0.01. Infant characteristics associated with greater odds of ketamine infusions were PH (aOR 5.47, 95% CI 1.65-18.09), stage II/III necrotizing enterocolitis (aOR 2.06, 95% CI 1.24-3.43), and tracheostomy (aOR 8.32, 95% CI 3.50-19.77) (Table 1). Conclusions In this large registry-based study, ketamine use among infants with sBPD increased steadily from 2010-2024. Increased odds of exposure were highest among infants with PH and those undergoing tracheostomy. The increasing rates of ketamine utilization underscore the need for future initiatives that evaluate the safety and efficacy of this therapy in infants with sBPD and PH. This abstract is funded by: None
Ransom et al. (Fri,) studied this question.