Abstract
Objective Bronchopulmonary dysplasia (BPD) is the most common late morbidity for premature
infants. Continuous neuromuscular blockade (CNMB) is suggested for the most unstable
phase of BPD, despite no outcome data. We explored the association between duration
of CNMB for severe BPD and mortality.
Design Medical record review of children <5 years old admitted from 2016 to 2022 with BPD
and one or more course of CNMB for ≥14 days.
Results Twelve children received a total of 20 episodes of CNMB for ≥14 days (range 14–173
d) during their hospitalization. Most (10/12) were born at <28 weeks' gestation and
most (11/12) with birth weight <1,000 g; 7/12 were of Black race/ethnicity. All were
hospitalized since birth. Most (10/12) were initially transferred from an outside
neonatal intensive care unit (ICU), typically after a >60-day hospitalization (9/12).
Half (6/12) of them had a ≥60-day stay in our neonatal ICU before transferring to
our pediatric ICU for, generally, ≥90 days (8/12). The primary study outcome was survival
to discharge: 2/12 survived. Both had shorter courses of CNMB (19 and 25 d); only
one child who died had a course ≤25 days. Just two infants had increasing length Z-scores
during hospitalization; only one infant had a final length Z-score > − 2.
Conclusion In this case series of infants with severe BPD, there were no survivors among those
receiving ≥25 days of CNMB. Linear growth, an essential growth parameter for infants
with BPD, decreased in most patients. These data do not support the use of ≥25 days
of CNMB to prevent mortality in infants with severe BPD.
Key Points
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This is a case series of neuromuscular blockade for severe BPD.
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Neuromuscular blockade did not improve linear growth.
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Ten out of 12 infants who were on prolonged neuromuscular blockade died.
Keywords
bronchopulmonary dysplasia - paralytic - pediatric - mortality
