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Hyperbilirubinemia following exposure to pancuronium bromide in newborns
J Freeman1, S M Lesko, A A Mitchell
1Slone Epidemiology Unit, School of Public Health, Boston University School of Medicine, Mass.
Insights
Pancuronium bromide may increase the risk of hyperbilirubinemia in newborn infants receiving mechanical ventilation. This risk is highest in the four days after the last pancuronium dose.
Area of Science:
- Neonatal Medicine
- Pediatric Pharmacology
- Clinical Toxicology
Background:
- Hyperbilirubinemia is a common concern in newborn infants.
- Mechanical ventilation is frequently required for critically ill neonates.
- Pancuronium bromide is a neuromuscular blocking agent used in neonatal intensive care.
Purpose of the Study:
- To investigate the association between pancuronium bromide administration and the risk of hyperbilirubinemia in mechanically ventilated newborn infants.
- To quantify the relative risk of hyperbilirubinemia in infants exposed to pancuronium bromide.
Main Methods:
- A case-control study comparing 129 infants treated with pancuronium bromide to 129 matched controls.
- Matching criteria included ventilatory status, hospital, birthweight, initial total serum bilirubin, and discharge date.
- Statistical analysis using adjusted summary relative risk (RR) was performed.
Main Results:
- The overall adjusted RR for hyperbilirubinemia in pancuronium-exposed infants was 1.2 (95% CI 1.1-1.4).
- The RR was highest during the 4 days following the last pancuronium dose (RR = 1.4; 1.0-1.8).
- A statistically significant increased risk of hyperbilirubinemia was observed.
Conclusions:
- Pancuronium bromide use in sick newborns may be associated with an increased risk of clinically significant hyperbilirubinemia.
- The findings suggest careful consideration of pancuronium bromide administration in neonates at risk for jaundice.
- Further research may be warranted to explore the underlying mechanisms and clinical implications.
Abstract:
We investigated the risk of hyperbilirubinemia in relation to the administration of pancuronium bromide among newborn infants requiring mechanical ventilation. One hundred and twenty-nine infants treated with pancuronium were compared to 129 infants who were never exposed, matched on ventilatory status, hospital, birthweight, initial total serum bilirubin, and date of hospital discharge. Overall, the adjusted summary relative risk (RR) for hyperbilirubinemia among pancuronium-exposed infants compared to nonexposed infants was 1.2 (95% confidence interval 1.1-1.4). The risk was greatest among exposed infants during the 4 days following the last dose of pancuronium (RR = 1.4; 1.0-1.8). These data suggest that the use of pancuronium in sick newborns may be associated with an increased risk of clinically important hyperbilirubinemia.