title: Limited professional guidance and literature are available to guide the safe use of neuromuscular block in infants.
abstract: OBJECTIVE
  Neuromuscular blocking agents (NMBAs) are used in a range of critical illnesses in neonates and infants, despite a lack of guidelines and professional standards. This study reviewed the current evidence base and ascertained UK practice regarding the continuous use of these agents in this age range.
  
  
  METHODS
  We reviewed the literature and carried out a telephone questionnaire of all tertiary units in England and specialist children's hospital neonatal units in the UK.
  
  
  RESULTS
  No best practice guidelines or general consensus statements were found, and the only randomised trial to feature an NMBA protocol expressed concerns about its use in such young babies. Of the 56 units contacted, 54 (96.4%) shared information. Only three of the 56 (5.4%) used intermittent boluses of NMBAs, 91.1% used NMBA infusions, 11 (19.6%) routinely used regular neuromuscular blocker pause to assess depth, and only one (1.8%) used peripheral nerve stimulation monitoring. All the units carried out clinical assessments, but only one (1.8%) had a written protocol.
  
  
  CONCLUSIONS
  There is a paucity of literature and professional standards to guide the safe use of NMBAs in infants. Of the 54 units who participated in the survey, only one had a protocol for using NMBAs in babies.
authors.affiliation: Paediatric and Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: Maik
authors.initials: M
authors.lastname: Honsel
authors.forename: Cristina
authors.initials: C
authors.lastname: Giugni
authors.forename: Joe
authors.initials: J
authors.lastname: Brierley
mesh_terms: D006801:Humans; D007223:Infant; D019148:Neuromuscular Blockade / Q000592:standards*; D009466:Neuromuscular Blocking Agents; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D006113:United Kingdom
chemical_list: D009466:Neuromuscular Blocking Agents
keywords: Critical care; Neonatology; Neuromuscular blockade; Neuromuscular monitoring; Pharmacology