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.