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Neonatal convulsions treated with continuous, intravenous infusion of diazepam
Insights
Continuous intravenous diazepam effectively stopped neonatal convulsions in infants suffering from perinatal asphyxia. Doses of at least 1 mg/h were required, with close monitoring ensuring adequate breathing and positive developmental outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Pharmacology
Background:
- Neonatal convulsions are a serious complication of severe perinatal asphyxia.
- Effective and safe treatment options for neonatal seizures are crucial.
Purpose of the Study:
- To evaluate the efficacy and safety of continuous intravenous diazepam infusion for treating neonatal convulsions in term infants.
Main Methods:
- Eight term infants with neonatal convulsions due to perinatal asphyxia received continuous intravenous diazepam infusion for 6-11 days.
- Doses ranged from 1.0-1.5 mg/h, with one infant requiring 2.75 mg/h.
- Serum diazepam concentrations and clinical responses were monitored.
Main Results:
- Diazepam infusion successfully stopped convulsions in all eight infants without recurrence after discontinuation.
- All infants maintained adequate respiration despite noted side-effects.
- Follow-up revealed normal psychomotor development in all cases, with one infant developing mild epilepsy.
Conclusions:
- Continuous intravenous diazepam infusion is an effective treatment for neonatal convulsions secondary to perinatal asphyxia.
- A starting dose of at least 1 mg/h (approximately 0.3 mg/kg/h) is recommended, with dose adjustments under close supervision.
- Monitoring of respiration and heart rate is essential during treatment to manage potential side-effects.
Abstract:
Eight patients born at term in the years 1974-76, with neonatal convulsions due to severe perinatal asphyxia, were treated for 6-11 days with continuous intravenous infusion of diazepam. Doses of 1.0-1.5 mg per hour (mg/h) were usually required to stop the convulsions. In one infant 2.75 mg/h was needed. During the treatment, all infants had measurable serum concentrations of diazepam, half of them above 35 mumol/1. The convulsions stopped in all eight infants, and did not return after discontinuation of the infusion. Side-effects were noted in all infants, but they were all able to breathe adequately. At follow-up the psychomotor development was normal in all cases and there were no signs of neurological disorders, except in one patient, in whom mild epilepsy was observed. Continuous infusion of diazepam should be given in doses of at least 1 mg/h (corresponding to around 0.3 mg/kg h) to stop convulsions in full-term infants efficiently and should be increased under close supervision and with monitoring of respiration and heart rate until treatment is effective.