Midazolam and the growing brain

[moliyen]

Much has been said that midazolam may hinder the growth of premature brains. On this basis, is it correct to prohibit the use of midazolam in the NICU? Any articles on pros and cons of its use.

[wackdi]

Hello!

Here are some articles on the topic (I hope this would help you):

Cochrane Review on Midazolam (free article):

Cochrane Database Syst Rev. 2003;(1):CD002052.

Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit.

Ng E, Taddio A, Ohlsson A.

Quite a good overview on the topic (mostly animal studies) (free article):

Anesth Analg. 2007 Mar;104(3):509-20.

Use of anesthetic agents in neonates and young children.

Mellon RD, Simone AF, Rappaport BA.

Intresting article about molecular mechanism of several drugs (free article):

Anesthesiology. 2009 Apr;110(4):703-8.

Update on neonatal anesthetic neurotoxicity: insight into molecular mechanisms and relevance to humans.

Patel P, Sun L.

A bit off topic but discusses midazolam in the field of intubation/sedation:

Pediatrics. 2010 Mar;125(3):608-15. Epub 2010 Feb 22.

Premedication for nonemergency endotracheal intubation in the neonate.

Kumar P, Denson SE, Mancuso TJ; Committee on Fetus and Newborn, Section on Anesthesiology and Pain Medicine.

Many greetings from Sweden

Dirk

[Stefan Johansson]

could this issue be an example of "confounding by indication", i.e. the underlying medical condition is associated with the outcome rather than the therapy. In this case, cns problems causing seizures relate to poor brain volume, not midazolam.

What do you think about that?

[moliyen]

My question arouse from a legal pitfall we´ve had in our country regarding the prohibition of midazolam in the NICU, related to the fact that the preservants (ethyl alcohol I believe) was causing developmental delays in prematures upon follow up. Other colleagues from South America have refer to midazolam as "poison" for the babies. On that respect, I needed feedback on others experiences regarding its use, pros and cons.

Thanks..........I wuld greatly appreciate articles (evidence based medicine) that approve or disapprove its use.

[Stefan Johansson]

My question arouse from a legal pitfall we´ve had in our country regarding the prohibition of midazolam in the NICU.

Would be interesting to hear more about the legal action against midazolam.