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VOLUME 22 , ISSUE 4 ( 2018 ) > List of Articles


Paradoxical reaction to midazolam in preterm neonates: A case series

Deepraj Hegde, Mahendra Gupta, Jayashree Mondkar

Keywords : Midazolam, neonatal period, seizures

Citation Information : Hegde D, Gupta M, Mondkar J. Paradoxical reaction to midazolam in preterm neonates: A case series. Indian J Crit Care Med 2018; 22 (4):300-302.

DOI: 10.4103/ijccm.IJCCM_36_17

License: CC BY-ND 3.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2018; The Author(s).


Midazolam is a drug belonging to the benzodiazepine group and is used commonly for seizure control as well as preoperative and procedure-related sedation in neonates. Many adverse effects of midazolam have been reported in the past. Paradoxical stimulation of the central nervous system such as restlessness, nightmare, and hallucinations as well as hypomanic behavior has been reported in adults and children. Seizure is a rare adverse effect of midazolam. Cases of myoclonic movements associated with midazolam have been published worldwide; however, none so far have been reported from India. We report two newborns in our Neonatal Unit, who developed myoclonic seizure after the administration of midazolam. Both of these neonates were preterm, require multiple invasive and noninvasive investigations also leads to parent and clinician stress.

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  1. Walter-Nicolet E, Annequin D, Biran V, Mitanchez D, Tourniaire B. Pain management in newborns: From prevention to treatment. Paediatr Drugs 2010;12:353-65.
  2. Mancuso CE, Tanzi MG, Gabay M. Paradoxical reactions to benzodiazepines: Literature review and treatment options. Pharmacotherapy 2004;24:1177-85.
  3. Pacifici GM. Clinical pharmacology of midazolam in neonates and children: Effect of disease-a review. Int J Pediatr 2014;2014:309342.
  4. Zaki SA. Adverse drug reaction and causality assessment scales. Lung India 2011;28:152-3.
  5. Ozcan B, Kavurt S, Yucel H, Bas AY, Demirel N. Rhythmic myoclonic jerking induced by midazolam in a preterm infant. Pediatr Neurol 2015;52:e9.
  6. Montenegro MA, Guerreiro MM, Caldas JP, Moura-Ribeiro MV, Guerreiro CA. Epileptic manifestations induced by midazolam in the neonatal period. Arq Neuropsiquiatr 2001;59:242-3.
  7. Adams MM, Hahn JS, Benitz WE. A series of neonatal patients with paradoxical seizures like reaction to bolus intravenous injection of midazolam. Pediatr Res 1997;41:134.
  8. van den Anker JN, Sauer PJ. The use of midazolam in the preterm neonate. Eur J Pediatr 1992;151:152.
  9. Zaw W, Knoppert DC, da Silva O. Flumazenil's reversal of myoclonic-like movements associated with midazolam in term newborns. Pharmacotherapy 2001;21:642-6.
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