Reviewed by Dr Carl Kuschel and Brenda Hughes
January 2001
Description information changed to note 2 different strengths December 2004
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Management of  Midazolam Administration



Slow IV Injection

  1. The first dose of midazolam in the non-ventilated baby is to be administered by the doctor/NS-ANP. If no adverse effects, nursing staff may administer subsequent doses.
  2. Further dilution is not necessary.
  3. Filter prior to administration through a Pall 0.22 micron filter.
  4. Administer by slow IV injection over 3-5 minutes.
  5. Is compatible with D5W, D10W and NS. Incompatible with IVN, phenobarbitone and ranitidine.
  6. Do NOT mix with other drugs, IV solutions, blood or blood products.

Continuous IV Infusion

Administered by a nurse with neonatal IV drug certification.

  1. Dilute midazolam immediately prior to use to required strength in D5W, NS.
  2. Administer via a syringe pump.
  3. Change fluid and tubing every 24 hours.
  4. Do NOT administer intra-arterially.

Nursing Considerations

  1. Before administering, have oxygen and resuscitation equipment available in case of severe respiratory depression.
  2. Monitor and record patient response to medication.
  3. Observe site closely for extravasation.
  4. Monitor for adverse reactions.
  5. Continuous cardiorespiratory monitoring.
  6. Monitor BP and oxygen saturation.
  7. Assess sedated infant for signs of pain (midazolam does not possess analgesic properties).


Selected References

1 Burtin P, Jacqz-Aigrain E, Girard P, et al. Population pharmacokinetics of midazolam in neonates. Clin Pharmacol Ther 1994;56:615-25
2 Jacqz-Aigrain E, Daoud P, Burtin P, Maherzi S, Beaufils F. Pharmacokinetics of midazolam during continuous infusion in critically ill neonates. Eur J Clin Pharmacol 1992;42(3):329-332
3 Harte GJ, Gray PH, Lee TC, Steer PA, Charles BG. Haemodynamic reponses and population pharmacokinetics of midazolam following administration to ventilated, preterm neonates. J Paediatr Child Health 1997;33(4):335-338
4 van Straarten HLM, Rademaker CMA, de Vries LS. Comparison of the effect of midazolam or vecuronium on blood pressure and cerebral blood flow velocity in the premature newborn. Dev Pharmacol Ther 1992;19:191-195.
5 Jacqz-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
6 Young TE, Magnum OB (eds). Neofax ‘95. A manual of drugs used in neonatal care, ed 8. Columbus, Ohio: Ross Products Division, Abbott Laboratories, USA, 1995, p136-7
7 Stockley I. Drug Interactions (4th ed). 1996.The Pharmaceutical Press. London.
8 Young TE, Mangum OB. Neofax : A manual of drugs used in neonatal care (ed 10). Raleigh, North Carolina: Acorn Publishing, USA, 1997, pp166-7.
9 Ng E, Taddio A, Ohlsson A.  Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit.  Cochrane Systematic Review 2000 Issue 2.  Update Software.