Short half-life benzodiazepines like midazolam are used as premedication to relieve intra-partum pain, and are known to have no adverse effects to the newborn. However, such short-acting drugs are known to induce paradoxical reactions when their concentration is abnormally elevated respect to the age of the subject. In a 1 day-old newborn, admitted to the Cardiology Unit of the "Bambino Gesù" Children Hospital of Rome due to a prenatal diagnosis of tetralogy of Fallot, a paradoxical reaction with a spontaneous resolution was observed. The analysis of urines, performed by gas chromatography/ mass spectrometry after a drug screening, showed the presence of the active metabolite 1-hydroxymidazolam at 9.7 μg/mL with no detectable trace of its precursor midazolam and of the alternative metabolite 4-hydroxymidazolam. On the basis of these evidences, we speculated that 1-hydroxymidazolam, produced by the mother's liver enzymes, passed to the newborn whose reduced volume of distribution (for the shunted circulation) favoured the onset of such a reaction. Hence, the toxicological approach should be carried out on both mother and child wherever the clinical picture may appear unexplainable or does not match with the other findings collected.
The importance of the toxicological analysis in newborns: Clearing the case of a tetralogy of Fallot with a paradoxical reaction to 1-hydroxymidazolam / Ialongo, C.; Marano, M.; Bertucci, P.; Marsella, L. T.; De Zorzi, A.; Bernardini, S.. - In: JOURNAL OF PEDIATRIC AND NEONATAL INDIVIDUALIZED MEDICINE. - ISSN 2281-0692. - 5:1(2016). [10.7363/050112]
The importance of the toxicological analysis in newborns: Clearing the case of a tetralogy of Fallot with a paradoxical reaction to 1-hydroxymidazolam
Ialongo C.
Primo
Writing – Original Draft Preparation
;
2016
Abstract
Short half-life benzodiazepines like midazolam are used as premedication to relieve intra-partum pain, and are known to have no adverse effects to the newborn. However, such short-acting drugs are known to induce paradoxical reactions when their concentration is abnormally elevated respect to the age of the subject. In a 1 day-old newborn, admitted to the Cardiology Unit of the "Bambino Gesù" Children Hospital of Rome due to a prenatal diagnosis of tetralogy of Fallot, a paradoxical reaction with a spontaneous resolution was observed. The analysis of urines, performed by gas chromatography/ mass spectrometry after a drug screening, showed the presence of the active metabolite 1-hydroxymidazolam at 9.7 μg/mL with no detectable trace of its precursor midazolam and of the alternative metabolite 4-hydroxymidazolam. On the basis of these evidences, we speculated that 1-hydroxymidazolam, produced by the mother's liver enzymes, passed to the newborn whose reduced volume of distribution (for the shunted circulation) favoured the onset of such a reaction. Hence, the toxicological approach should be carried out on both mother and child wherever the clinical picture may appear unexplainable or does not match with the other findings collected.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.