Indian Pediatrics 2002; 39:316  

Midazolam Sedation in Mechanically Ventilated Newborns

The recent communication(1) on this subject was interesting. Midazolam being a benzodiazapine with short half life is ideal for sedation in neonates. However, morphine itself has sedative effect in preterm neonates and no additional drug is required(2). It would be more useful to compare morphine analgesia to other single drugs like fentanyl, dimorphine and midazolam(3-5). All of them have the same catecholamine reducing effect. In fact we have used midazolam infusion (without Morphine) effectively for ventilating very low birth weight (VLBW <1500 g) babies. Anand et al. have reported high incidence of intraventriculer hemorrhage (IVH) with midazolam(5). In our unit, 4 of 32 ventilated VLBW babies had >Gr-II IVH and 1 of these who had Gr-IV IVH expired. The other 3 have normal neurodevelopmental outcome at 1 year. This incidence of IVH is comparable to other outcome studies in VLBW babies(6).

We observed moderate hypotension in 6/32 (19%) babies. No other adverse effect was noted. Jacqz et al. have also reported good response with midazolam(7). We would like to share the experience of other units using midazolam infusion for ventilating preterm babies.

A. Kulkarni,
Senior Consultant,
Department of Neonatal Medicine,
Indraprastha Apollo Hospital,
6, Ishwar Nagar, Mathura Road,
New Delhi 110 065, India.
E-mail: [email protected]

1. Arya V, Ramji S. Midazolam sedation in mechanically ventilated newborns. Indian Pediatr 2000; 38: 967-972.

2. Jaczq-Aigrain E, Burtin P. Clinical pharmacokinetics of sedatives in neonates. Clin Pharmacokinet 1996; 31: 423-443.

3. Saarenmaa E, Huttunen P, Leppaluoto J, Meretoja O, Fellman V. Advantages of fentanyl over morphine in analgesis for ventilated newborn infants after birth: A randomized trial. J Pediatr 1999; 134: 127-129.

4. Wood CM, Rushforth JA, Hartley R, Dean H, Wild J, Levene MI. Randomized double blind trial of morphine versus diamorphin for sedation of preterm neonates. Arch Dis Child Fetal Neonatal 1996; 79: F34-F39.

5. Anand KJ, Batron BA, McIntosh N, Lagercrantz H, Pelausa E, Young TI. Analgesia and sedation in preterm neonates who require ventilatory support: Results from the NOPAIN trial. (Neonatal Outcome and Prologned Analgesia in Neonates). Arch Pediatr Adolesc Med 1999; 153: 33-38.

6. Chang SC, Lin CH, Lin YJ, Yeh TF. Mortality, morbidity, length and cost of hospitalization in very-low-birth-weight infants in the era of National Health Insurance in Taiwan: A medical center's experience. Acta Pediatr Taiwan 2000; 41: 308-312.

7. Jaczq-Aigrain E, Daoud P, Burtin P, Desplanques L, Beaufils F. Placebo-controlled trial of midazolam sedation in mechanically ventilated newborn babies. Lancet 1994; 344: 646-650.