Temporal trends and clinical factors associated with ketamine infusion in hospitalized infants with bronchopulmonary dysplasia

OBJECTIVE: To characterize temporal trends in ketamine infusion use in extremely preterm infants with severe bronchopulmonary dysplasia (sBPD) and identify associated clinical factors. STUDY DESIGN: We conducted a 15-year (2010-2024) retrospective cohort study of extremely preterm infants with sBPD. Time was analyzed as a categorical variable in three 5-year epochs. Ketamine exposures were described, and multivariable logistic regression estimated associations between time periods and use, adjusting for clinical characteristics. RESULTS: Among 8888 infants with sBPD, 112 (1.3%) received ketamine infusion, with use increasing over time and rising most sharply between 2020 and 2024. Pulmonary hypertension (adjusted odds ratio, aOR 5.47, 95% CI 1.65-18.09), stage II/III necrotizing enterocolitis (aOR 2.06, 1.24-3.43), and tracheostomy (aOR 8.32, 3.50-19.77) were independently associated with use. CONCLUSIONS: Ketamine infusions in sBPD are uncommon but have increased over time, particularly since 2020. Use is associated with markers of greater illness severity.