Universität zu Köln

Welzing, L., Junghaenel, S., Weiss, V., Roth, B., Mueller, C. and Wiesen, M. H. J. (2013). Disposition of Midazolam in Asphyxiated Neonates Receiving Therapeutic Hypothermia - A Pilot Study. Klinische Padiatr., 225 (7). S. 398 - 405. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1439-3824

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Abstract

Background: Moderate hypothermia has become an established therapy for asphyxiated neonates. Midazolam is a frequently used sedative for this indication, although it has never been investigated how therapeutic hypothermia and asphyxia influence midazolam metabolism in neonates. Patients and Methods: 9 asphyxiated newborns were treated with whole body hypothermia of 32-34 degrees C for 72 h and all of them received continuous midazolam infusion for sedation. Serum concentrations of midazolam and its metabolites 1-hydroxy-midazolam and 4-hydroxy-midazolam were measured during hypothermia and the rewarming period. Renal and hepatic parameters were assessed to take into account the influence of asphyxia related renal or hepatic impairment. Results: We found a high interindividual variability of serum midazolam concentrations in asphyxiated neonates with therapeutic hypothermia; median midazolam concentration was 369.3ng/ml (minimum 36.6; maximum 3218.6ng/ml). The population pharmacokinetic model revealed a midazolam clearance of 2.57ml/kg/min, comparable to midazolam clearances observed in normothermic critically ill neonates. However, midazolam clearance was significantly decreased in patients with asphyxia related renal and hepatic impairment. Conclusion: It seems that isolated hypothermia does not significantly influence midazolam metabolism. However, neonates with asphyxia related hepatic and renal impairment are at risk of generating unexpectedly high serum midazolam concentrations. In addition pronounced interindividual variability of midazolam metabolism may contribute to dangerously high midazolam concentrations.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Welzing, L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Junghaenel, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Weiss, V. UNSPECIFIED UNSPECIFIED UNSPECIFIED Roth, B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wiesen, M. H. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-470506
DOI:	10.1055/s-0033-1358749
Journal or Publication Title:	Klinische Padiatr.
Volume:	225
Number:	7
Page Range:	S. 398 - 405
Date:	2013
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1439-3824
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language POPULATION PHARMACOKINETICS; SYSTEMIC HYPOTHERMIA; MODERATE HYPOTHERMIA; MASS-SPECTROMETRY; CONTROLLED-TRIAL; HUMAN PLASMA; ENCEPHALOPATHY; FENTANYL; 4-HYDROXYMIDAZOLAM; METABOLISM Multiple languages Pediatrics Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/47050