Abstracts

Seizures are indicative of underlying neurologic dysfunction in neonates. Repeated seizures may be deleterious to the brain even without disturbances of ventilation or perfusion.
Seizures are refractory to first line antiepileptic drugs (AEDs), phenobarbital (PB)and phenytoin (PHT) in 20-50% of children. In neonates AEDs can be even less effective in controlling seizures. Rapid control of status epilepticus with midazolam has been demonstrated in 2 previous studies with complete clinical and electrographic response in neonates who did not respond to PB and PHT., We report our experience with 3 neonates with status epilepticus secondary to HIE, Group B Streptococcal (GBS) meningitis and Ohtahara syndrome. The age at presentation was 1 day for the neonates with HIE and Ohtahara syndrome. The neonate with GBS meningitis presented at 23 days. Midazolam was initiated on day 2 of seizures for the neonates with HIE and meningitis. The neonate with Ohtahara syndrome initially was started on pentobarbital drip day 2 of seizures; midazolam was initiated day 4 as there was lack of response to PB, PHT and pentobarbital., Seizures in all 3 neonates did not respond to PB (levels of 50-60 mcg/ml) and PHT (18-22 mcg/ml). The neonate with Ohtahara syndrome did not respond to pentobarbital in addition. Seizures in all responded to midazolam infusion. The neonate with meningitis developed hypotension which responded to inotropic support. There were no significant cardio-vascular side effects in any of the neonates. The neonate with Ohtahara syndrome who had received pentobarbital developed Necrotizing Enterocolitis prior to initiation of midazolam. Midazolam loading dose was used in the neonate with Ohtahara syndrome.
Clinical and electrographic seizure control was acheived within a range of 6-72 hours after initiation of midazolam. The maximum dose of midazolam dose used was 0.2 mg/kg/hr., Midazolam was effective in the management of 3 neonates with refractory seizures that did not respond to PB, PHT and pentobarbital. Midazolam may be considered a safe and effective AED in refractory neonatal seizures of diverse etiologies. Midazolam may help acheive relatively rapid clinical and electrographic seizure control. This may be an important factor in decreasing the severity of neurodevelopmental sequelae.,