Midazolam Intoxication in a Premature Neonate

Endo, Mio; Hirano, Ryohei; Shibasaki, Hiromi; Yokokawa, Akitomo; Furuta, Takahisa; Abe, Kurumi; Morita, Koji; Tanaka, Sachiko; Hirano, Toshihiko; Sakurai, Motoichiro; Mizuno, Katsumi

doi:10.1016/j.clinthera.2020.03.013

Clinical Therapeutics

2020

DOI: 10.1016/j.clinthera.2020.03.013

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Midazolam Intoxication in a Premature Neonate

Mio Endo

Ryohei Hirano

Hiromi Shibasaki

et al.

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Cited by 3 publications

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“…21 We applied this method to evaluate CYP3A activity using a one-point blood sample in a 2-year-old male patient who had higher midazolam plasma concentrations and confirmed that this patient had low CYP3A activity. 22 Instead of venous blood sampling, DBS sampling can also be applied to any populations and is easy to handle during measurement. Hence, because DBS samples contain only 15-25 μl/spot of whole blood, there is a necessity to establish a more sensitive and accurate analytical method for measuring 6β-OHF and cortisol in DBS for evaluating CYP3A activity using DBS.…”

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Dried blood spots analysis of 6β‐hydroxycortisol and cortisol using liquid chromatography/tandem mass spectrometry for calculating 6β‐hydroxycortisol to cortisol ratio

et al. 2021

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Dried blood spot (DBS) sampling is a minimally invasive method used to collect blood samples of any population for personalized medicine. We aimed to develop a sensitive and reliable analytical method for measuring 6β-hydroxycortisol (6β-OHF) and cortisol concentrations in DBS by liquid chromatography/tandem mass spectrometry so as to utilize DBS as a less invasive blood sampling method for calculating the ratio of 6β-OHF/cortisol. The lower limits of quantification obtained using four DBS were 1.08 pg/50 μl for 6β-OHF and 1.01 pg/50 μl for cortisol. The 6β-OHF and cortisol in DBS were stable for 28 days at room temperature. The intraday and interday accuracy and precision of the method was <12%. Additionally, the 6β-OHF and cortisol in DBS were measured before, during, and after 3 days of clarithromycin administration to two of the subjects. Then, their concentration was compared in the plasma and whole blood collected simultaneously. The concentrations of 6β-OHF and cortisol in four DBS ranged from 0.007 to 0.079 ng/50 μl and from 1.15 to 6.66 ng/50 μl, respectively. The 6β-OHF/cortisol ratio in DBS decreased by approximately 50% on administering clarithromycin compared with that before the administration of clarithromycin. The 6β-OHF/cortisol ratio in DBS also showed a strong correlation with that in whole blood (r = 0.9694) and plasma (r = 0.9383). This method provides high accuracy and precision for measuring 6β-OHF and cortisol in DBS. It also allows the use of DBS instead of plasma for calculating the 6β-OHF/cortisol ratio. The 6β-OHF/cortisol ratio could be an index of CYP3A activity in clinical setting.

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confidence: 99%

Dried blood spots analysis of 6β‐hydroxycortisol and cortisol using liquid chromatography/tandem mass spectrometry for calculating 6β‐hydroxycortisol to cortisol ratio

et al. 2021

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Dexmedetomidine/midazolam interaction

2020

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The Use of Midazolam as an Antiseizure Medication in Neonatal Seizures: Single Center Experience and Literature Review

Falsaperla

Collotta

Sortino

et al. 2024

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Background: Existing therapeutic alternatives for neonatal crises have expanded in recent decades, but no consensus has been reached on protocols based on neonatal seizures. In particular, little is known about the use of midazolam in newborns. Aim: The aim of our study is to evaluate the response to midazolam, the appearance of side effects, and their impact on therapeutic decisions. Methods: This is a STROBE-conformed retrospective observational study of 10 patients with neonatal seizures unresponsive to common antiseizure drugs, admitted to San Marco University Hospital’s neonatal intensive care (Catania, Italy) from September 2015 to October 2022. In our database search, 36 newborns were treated with midazolam, but only ten children met the selection criteria for this study. Results: Response was assessed both clinically and electrographic. Only 4 patients at the end of the treatment showed a complete electroclinical response; they were full-term infants with a postnatal age greater than 7 days. Non-responders and partial responders are all premature (4/10) or full-term neonates who started therapy in the first days of life (<7th day) (2/10). Conclusion: Neonatal seizures in preterm show a lower response rate to midazolam than seizures in full-term infants, with poorer prognosis. Liver and renal function and central nervous system development are incomplete in premature infants and the first days of life. In this study, we show that midazolam, a short-acting benzodiazepine, appears to be most effective in full-term infants and after 7 days of life

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Midazolam Intoxication in a Premature Neonate

Cited by 3 publications

References 13 publications

Dried blood spots analysis of 6β‐hydroxycortisol and cortisol using liquid chromatography/tandem mass spectrometry for calculating 6β‐hydroxycortisol to cortisol ratio

Dried blood spots analysis of 6β‐hydroxycortisol and cortisol using liquid chromatography/tandem mass spectrometry for calculating 6β‐hydroxycortisol to cortisol ratio

Dexmedetomidine/midazolam interaction

The Use of Midazolam as an Antiseizure Medication in Neonatal Seizures: Single Center Experience and Literature Review

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