A Powerful Sedative Is Being Used More Often in Premature Babies With Serious Lung Disease

Doctors in the United States are using a medicine called ketamine more often to help very premature babies with a serious lung disease. The disease is called bronchopulmonary dysplasia, or BPD. Babies born before 28 weeks of pregnancy are most at risk for this condition. A new study looked at hospital data from across the country to learn how often ketamine was being used and which babies were most likely to receive it.

BPD happens when a baby's lungs do not develop fully before birth. Babies with severe BPD often need machines to help them breathe for a long time. They may also have high blood pressure in their lungs, which doctors call pulmonary hypertension. These babies usually stay in the hospital for many months and need a lot of medical care.

To keep these babies calm and comfortable, doctors use medicines called sedatives. Common ones include opioids and benzodiazepines. These drugs work well, but using them for too long can cause serious problems, like making a baby dependent on them. That is why doctors are searching for safer choices.

Ketamine is a medicine that has been used as an anesthetic for many years. It is special because it usually does not stop a patient from breathing on their own. It can also help open up tight airways, which matters a lot for babies with BPD. Because of these features, some doctors began trying ketamine in the sickest premature babies.

Researchers studied records from nearly 9,000 extremely premature babies with severe BPD between 2010 and 2024. About 9 out of every 100 babies received ketamine at some point during their hospital stay. Only about 1 out of every 100 babies received it as a steady drip through a tube — called a continuous infusion — for two or more days.

Even though the numbers were small, the trend was easy to see. Ketamine use more than doubled in the most recent years of the study. Only about 0.7% of babies received ketamine infusions from 2010 to 2014. But from 2020 to 2024, that number climbed to about 1.8%.

The babies most likely to receive ketamine were also the sickest ones. Those with high lung blood pressure were about five times more likely to get ketamine. Babies with a serious gut infection called necrotizing enterocolitis were about twice as likely. Babies who needed a small tube placed in their throat to help them breathe — called a tracheostomy — were more than eight times as likely to receive ketamine.

Ketamine has some properties that make it useful for babies with severe BPD. It helps relax the muscles around the airways so breathing becomes easier. It also tends to keep heart rate and blood pressure steady. For babies with high pressure in their lung blood vessels, ketamine seems less likely to make that problem worse than other sedatives.

Still, ketamine is not without risks. In some babies, it can raise the heart rate and blood pressure too much. Babies also have immature livers, meaning they take longer to process the drug, which can allow it to build up to unsafe levels. Doctors are also concerned about how ketamine might affect a baby's developing brain, since these infants are already at risk for developmental problems.

Scientists and doctors agree that ketamine is a promising extra tool for the sickest premature babies, but they say much more research is needed. They are calling for careful studies that look at the right doses, the best ways to monitor babies, and the long-term effects on brain growth. The goal is to make sure every premature baby receives the safest and most effective care possible.