MIDAZOLAM IN THE TREATMENT OF REFRACTORY NEONATAL SEIZURES

Midazolam, a potent short-acting benzodiazepine, is a safe and highly effective agent for the control of status epilepticus. Its efficacy in the control of neonatal seizures, however, has not been determined. S ix neonates (aged 1-9 days; gestation, 30-41 weeks) developed seizures from a variety of causes. In each case, seizures persisted for >12 h despite high-dose phenobarbital therapy with or without the addition o f phenytoin. Midazolam was then administered by continuous intravenous infusion (0.1-0.4 mg/kg/h) for 1 to 3 days. Within 1 h of initiation of midazolam, seizures were controlled in all six neonates. Electroenc ephalographic seizures were abolished in four of six neonates; however , two neonates continued to have electrographic seizures (without clin ical accompaniment) for a further 12 h. Blood pressure and pulse rate were not changed after the initiation of midazolam, and adverse reacti ons were not observed in any neonate. Because more than one third of a ll neonatal seizures are refractory to high-dose phenobarbital and phe nytoin, midazolam administered by continuous intravenous infusion may be a valuable adjunctive therapy.