Midazolam Induced Abnormal Movements in Preterm Newborns: Case Series

Abstract

Objectives − The aim of our article is to highlight the adverse effects of midazolam, which causes abnormal behavior and a paradoxical behavioral reaction, although it is used for sedation and seizure control, as well as preoperative and procedure-related sedation in neonates.

Case Presentation − We report myoclonic seizure-like abnormal activity in four preterm neonates, who received intravenous midazolam for sedation before laser photocoagulation for retinopathy of prematurity and seizures. All neonates had a long NICU stay, but were clinically well before undergoing the procedure. Cases 1, 2 and 3 developed multifocal seizure-like abnormal movements after receiving a midazolam injection for photocoagulation therapy for retinopathy of prematurity. Case 4 developed multifocal seizure-like abnormal movements after receiving an injection of midazolam for seizures. In all the cases the seizure-like abnormal movements were controlled by phenobarbitone.

Conclusion − Midazolam is increasingly being used in NICUs, but caution must be exercised while administering it in preterm neonates with comorbidities. It is difficult to identify the neonates at risk, but it is necessary to be aware of and cautious about the adverse effects of midazolam when administering the drug.