Neonatal Convulsions Treated with Continuous, Intravenous Infusion of Diazepam

Eight patients born at term in the years 1974-76, with neonatal convulsions due to severe perinatal asphyxia, were treated for 6-11 days with continuous intravenous infusion of diazepam. Doses of 1.0-1.5 mg per hour (mg/h) were usually required to stop the convulsions. In one infant 2.75 mg/h was needed. During the treatment, all infants had measurable serum concentrations of diazepam, half of them above 35 mumol/1. The convulsions stopped in all eight infants, and did not return after discontinuation of the infusion. Side-effects were noted in all infants, but they were all able to breathe adequately. At follow-up the psychomotor development was normal in all cases and there were no signs of neurological disorders, except in one patient, in whom mild epilepsy was observed. Continuous infusion of diazepam should be given in doses of at least 1 mg/h (corresponding to around 0.3 mg/kg h) to stop convulsions in full-term infants efficiently and should be increased under close supervision and with monitoring of respiration and heart rate until treatment is effective.