Professor of Pediatrics Connecticut Children's Medical Center Farmington, Connecticut, United States
Background: Very low birth weight (VLBW) infants need analgesia and sedation during a laser retinal ablation procedure for threshold retinopathy of prematurity (ROP). Ketamine has been used for analgosedation during ROP procedures at Connecticut Children’s since 2011. Ketamine, a rapidly acting, non-barbiturate anesthetic, is well studied in children; however, its birth weight-related short and long-term effects in VLBW infants are poorly understood. Objective: To describe the use of Ketamine analgosedation for ROP laser ablation procedure and to explore its birthweight (BW) based association with (i) short-term cardiorespiratory and (ii) long-term neurodevelopmental outcomes. Design/Methods: A retrospective cohort study was done of VLBW infants admitted between 11/2011 and 12/2020 and given Ketamine analgosedation for ROP laser procedure. A loading dose (1 mg/k) of intravenous Ketamine was given, followed by continuous infusion (0.01-0.03 mg/k/min) during the procedure. Vitals were monitored during the procedure and hourly for 8h post-procedure. Adverse cardiorespiratory events, including intubation during the procedure and 24h post-procedure, were collected. Long-term developmental outcomes at 18-24 m. corrected age were assessed using the Bayley Scales of Infant Development (BSID III or IV). Outcomes were compared between infants with BW < 600 gm and BW>600 gm using univariate analyses. Results: 54 VLBW infants were included: 23 (43%) in BW < 600 gm group and 31 (57%) in BW>600 gm. Long-term neurodevelopmental data were available for 28 (52%) infants. There were no demographic differences in the two groups except for BW and GA. (Table 1) There were no significant differences in cardiorespiratory events during or post-procedure between the two BW groups. (Table 2)
BSID-III/IV analyses were done at relatively earlier chronologic and corrected ages for the BW>600 gm group. Although not statistically significant, cognitive, language, and motor scores were higher in BW>600 gm infants. (Table 3) Hearing loss and strabismus occurred only in BW < 600 gm infants.
Conclusion(s): Our small retrospective study showed that the use of Ketamine for laser retinal ablation was effective and safe during the procedure, irrespective of birth weight. It was not associated with adverse cardiorespiratory events in the first 24 hours post-procedure. Long-term neurodevelopmental assessment showed a trend toward worse outcomes in the BW < 600 gm group. However, the effect of Ketamine versus the impact of higher BW cannot be differentiated due to limited sample size. Larger prospective studies are needed to evaluate these effects comprehensively.
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