Chloral hydrate toxicity in a preterm infant

Ventilator care in premature infants with hyaline membrane disease (HMD) may be complicated by episodes of irritability and 'fighting' the respirator, resulting in significant hypoxemia. Neuromuscular blockade with pharmacologic agents such as pancuronium bromide is frequently used to manage this problem [Crone and Favorito, 1980]. This therapy results in the loss of important clinical signs, such as alterations in muscle tone and spontaneous movements, which are important in monitoring the critically ill newborn. As a result of these considerations, we occasionally have utilized the sedative-hypnotic effects of chloral hydrate to achieve adequate ventilation and oxygenation in these infants. We report, however, a case of a preterm infant who developed severe chloral hydrate toxicity after its administration as an adjunct to the treatment of HMD.