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Published on: November 20, 2015
Analgesia and sedation increases bronchopulmonary dysplasia risk without significant neurodevelopmental impairment in
Bowen Weng1, Chongbing Yan1, Yuanyang Zhang1
1Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Insights
Analgesia and/or sedation exposure in very preterm infants is linked to increased risks of bronchopulmonary dysplasia (BPD) or death. However, this study found no significant long-term neurodevelopmental harm at 18 months in a Chinese cohort.
Area of Science:
- Neonatal Medicine
- Pediatric Pharmacology
- Critical Care Medicine
Background:
- Associations between analgesia/sedation and adverse outcomes in very preterm infants are controversial.
- Limited evidence exists for moderate-to-severe bronchopulmonary dysplasia (BPD) and long-term neurodevelopmental outcomes in large Chinese preterm cohorts.
Purpose of the Study:
- Investigate associations between analgesia/sedation exposure and the composite outcome of BPD or death.
- Assess the association with neurodevelopmental outcomes at 18 months.
Main Methods:
- Retrospective cohort study of preterm infants (<32 weeks gestation) in Shanghai (2018-2022).
- Primary outcomes: moderate-to-severe BPD or death, any BPD or death.
- Propensity score matching (PSM) and multivariable logistic regression used for confounder adjustment.
Main Results:
- Analgesia/sedation exposure (16.3%) was associated with significantly increased risk of moderate-to-severe BPD or death (aOR, 6.00) and any BPD or death (aOR, 5.32).
- Exposure linked to longer invasive mechanical ventilation (IMV), increased hypotension, and feeding intolerance.
- No significant associations found with neurodevelopmental outcomes at 18 months in the matched subcohort.
Conclusions:
- In a large Chinese preterm cohort, analgesia/sedation exposure significantly increased the risk of BPD or death.
- This association occurred with prolonged IMV and hemodynamic instability.
- No significant long-term neurodevelopmental harm was detected at 18 months.
Background:
The associations between analgesia and/or sedation exposure and adverse outcomes in very preterm infants remain controversial. Evidence linking these medications to moderate-to-severe bronchopulmonary dysplasia (BPD) and long-term neurodevelopmental outcomes is particularly limited in large Chinese preterm cohorts.
Objective:
The primary aim was to investigate the associations between exposure to analgesia/sedation and the composite outcome of BPD or death. The secondary aim was to assess the association with neurodevelopmental outcomes at 18 months.
Methods:
This large, retrospective cohort study included preterm infants (gestational age < 32 weeks) admitted to a tertiary NICU in Shanghai, China, from 2018 to 2022. The primary outcomes were two composite measures: (1) moderate-to-severe BPD or death, and (2) any BPD or death, both assessed at 36 weeks postmenstrual age. The secondary outcomes included neurodevelopmental outcomes at 18 months and key neonatal morbidities. Propensity score matching (PSM) followed by multivariable logistic regression was used to adjust for confounders.
Results:
Of the 713 infants included in the primary analysis, 116 (16.3%) were exposed to analgesia/sedation. In the PSM cohort (n = 460), after multivariable adjustment, exposure was associated with a significantly increased risk of moderate-to-severe BPD or death (adjusted OR, 6.00; 95% CI, 3.35-10.74; p < 0.001) and any BPD or death (adjusted OR, 5.32; 95% CI, 3.15-8.98; p < 0.001). Furthermore, the exposure group experienced significantly longer durations of invasive mechanical ventilation (IMV), higher incidences of hypotension requiring intervention and feeding intolerance (all p < 0.05). In a separate analysis of the matched neurodevelopmental subcohort (n = 129), no significant associations were found with neurodevelopmental outcomes at 18 months.
Conclusion:
In this large Chinese preterm cohort, analgesia/sedation exposure was significantly associated with an increased risk of BPD or death. This association was observed alongside a series of neonatal morbidities such as prolonged IMV and hemodynamic instability, though no significant long-term neurodevelopmental harm was detected at 18 months.
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