Continuous midazolam infusion in the treatment of uncontrollable neonatal seizures

A prospective open-label study was designed to determine the efficacy and safety of continuous midazolam infusion in neonates with uncontrollable neonatal seizures. Patients whose seizures could not be controlled by diazepam, phenytoin or phenobarbital were enrolled. Midazolam was given as an intravenous bolus dose followed by continuous intravenous infusion. Thirty-two patients fulfilled the inclusion criteria. Midazolam terminated the seizures in all patients. The maximum dose of midazolam ranged from 1 microgram/kg/min to 15 micrograms/kg/min, with average of 4 micrograms/kg/min. Four patients had recurrent seizures, which stop after midazolam was reinstituted. There were no significant changes in serum sodium, potassium, calcium or glucose in any of the patients. Adverse effects included hypotension in 12 patients (38%) that was successfully controlled with intropic agents (dopamine and/or dobutamine) and transient urinary retention in 12 (38%). Our study suggests that midazolam is safe and effective for the treatment of uncontrollable neonatal seizures.