Electro-clinical efficacy and safety of midazolam in neonatal seizures: a systematic review with individual level exploratory analysis of gestational age-related treatment response.
Eur J PediatrSep 14, 2026 (epub)
Raffaele Falsaperla, Vincenzo Sortino, Carla Cimino et al.
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In 30 seconds
This systematic review evaluated the electro-clinical efficacy and safety of midazolam in treating neonatal seizures, involving 146 neonates. The study found an electro-clinical response in 69.2% and seizure cessation in 41.8% of cases. An exploratory analysis suggested that higher gestational age correlates with improved treatment response.
Key findings
- Electro-clinical response to midazolam was observed in 101 out of 146 neonates (69.2%).
- Seizure cessation was achieved in 61 out of 146 neonates (41.8%).
- Higher gestational age was associated with a greater probability of electro-clinical response.
- Hypotension was the most frequently reported adverse event.
Why it matters
The findings highlight the potential role of midazolam as an add-on treatment for refractory neonatal seizures, addressing a significant clinical challenge where first-line therapies often fail.
What to keep in mind
The evidence is limited by heterogeneity in study design, EEG monitoring strategies, and incomplete individual-level data.