Lorazepam in the treatment of refractory neonatal seizures

Lorazepam is a benzodiazepam anticonvulsant with proven efficiency in older infants and children. Few studies have evaluated the effect of this agent in newborns. We report the results of treatment of intractable seizures with lorazepam in seven neonates (3 boys, 4 girls). Six infants were full term and one was premature. Three patients had hypoxic-ischemic encephalopathy, two had intracranial hemorrhage, one had congenital CNS malformation and one had bacterial meningitis. Conventional anticonvulsant therapy consisting of appropriate intravenous loading doses of phenobarbital (20 mg/kg/d) and phenytoin (15 mg/kg/d) did not control their seizures. Lorazepam was administered at a dose of 0.1 mg/kg and repeated up to 3 doses if necessary. EEG was performed on these patients prior to treatment with lorazepam. Two patients received one dose of lorazepam, three received two doses and two received three doses. Five patients responded with complete cessation of seizures with no recurrent seizures for more than 24 hours. One patient responded but seizures recurred at 12 hours and the remaining patient had a reduction of seizures. No patients developed apnea or hypotension during or immediately after infusion of lorazepam and no other adverse effects were observed. Our data suggests lorazepam might be as effective as diazepam but it has a longer duration of action and fewer side effects. We conclude that lorazepam can be considered a drug of choice for acute seizure control in newborns with intractable seizures which are resistant to phenobarbital and phenytoin treatment.