Abstract
As the survival of preterm infants has improved, several previously unrecognized complications of prematurity and its therapy have been identified. Pancuronium (Pavulon), a neuromuscular blocking agent, has been used to paralyze infants in order to facilitate ventilator therapy. We have recently seen abnormalities in the skeletal muscle fibers at autopsy of two 30-31 week gestation infants, each of whom received pancuronium in standard doses (0.1 mg/kg) for more than 4 weeks. The psoas and other skeletal muscles showed microscopic changes consistent with disuse atrophy. Morphometric studies of psoas muscle using a computerized video analysis system were performed. The least diameter of 100 fibers from each case was counted. As controls, psoas from 18 infants dying within one week of birth were examined, 9 were matched for age at birth (30-31 weeks) and 9 for age at death (35-36 weeks). Ideal controls, infants born at 30-31 weeks who died at 4 weeks and did not receive pancuronium, were not available. The mean fiber diameters of the 30-31 week (4.1 μ ± 0.3) and the 35-36 week controls (5.1 μ ± 0.7) were significantly different (p<0.01). Those of the cases treated with pancuronium (3.3 μ ± 0.7) were significantly smaller than either control group. Prolonged pancuronium therapy in premature infants may lead to skeletal muscle atrophy, which may be the cause of temporary hypotonia and may be confused with neurologic disease. The long-term implications are not known.
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Rutledge, M., Hawkins, E. & Langston, C. 1503 SKELETAL MUSCLE ATROPHY INDUCED IN NEWBORNS BY CHRONIC PANCURONIUM TREATMENT. Pediatr Res 19, 361 (1985). https://doi.org/10.1203/00006450-198504000-01527
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DOI: https://doi.org/10.1203/00006450-198504000-01527