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Respiratory depression in children receiving diazepam for acute seizures: a prospective study
Insights
Diazepam use in children with seizures can cause respiratory depression, with a 9% incidence observed. This high rate, especially with intravenous or rectal administration, suggests a need to re-evaluate its first-line use in pediatric emergencies.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pharmacology
- Neurology
Background:
- Acute seizures in children are a common pediatric emergency.
- Diazepam is frequently used for seizure management.
- The incidence of respiratory depression associated with diazepam in pediatric patients requires thorough investigation.
Purpose of the Study:
- To determine the incidence of respiratory depression following diazepam administration in children presenting with seizures.
- To assess the risk of respiratory complications based on the route of diazepam administration.
Main Methods:
- Prospective study of children presenting with seizures to a pediatric A&E department over 9 months.
- Defined respiratory depression as decreased respiratory rate, oxygen saturation, or apnea requiring intervention.
- Documented diazepam administration route (rectal, intravenous, or both) and subsequent respiratory events.
Main Results:
- 122 patient episodes involved diazepam administration.
- Overall incidence of respiratory depression was 9% (11 out of 122 episodes).
- Eight children required ventilation due to respiratory depression, indicating a significant risk.
Conclusions:
- Diazepam administration, particularly via intravenous or rectal routes, is associated with a high incidence of respiratory depression in children with acute seizures.
- The findings necessitate a review of diazepam's role as a first-line therapy for pediatric seizures.
- Further research into safer alternatives or optimized administration protocols for diazepam in this population is warranted.
Abstract:
The aim of this study was to determine the incidence of respiratory depression following the use of diazepam in children presenting with seizures. All children presenting with seizures to a children's A & E department over a period of 9 months were studied prospectively. Respiratory depression was defined as a fall in respiratory rate or oxygen saturation, or apnoea resulting in ventilation or resuscitation with bag-and-mask oxygen. There were 130 patient episodes involving 97 children who received treatment for their seizures before admission and/or in the A & E department. Administration of diazepam resulted in 122 patient episodes. The route of administration was rectal in 91 episodes, intravenous in 12 episodes, and both rectal and intravenous in 19 episodes. Eleven children had respiratory depression in relation to diazepam administration. Eight of these children required ventilation. The overall incidence of respiratory depression following the use of diazepam was 9%. The incidence of respiratory depression following diazepam given intravenously or rectally is high. The use of diazepam as first-line therapy for children with acute seizures needs to be reviewed.