Reversal of Benzodiazepine-Induced Myoclonus by Flumazenil in the Neonatal Intensive Care Unit
Bibliographic record
Abstract
This is a late preterm, 36 1/7 gestational weeks, admitted to the neonatal intensive care unit for severe renal dysplasia secondary to obstructive uropathy, and pulmonary hypoplasia complicated with pulmonary hypertension. On the 12th day of life, sedation with lorazepam 0.1 mg/kg was administered in preparation for an invasive procedure. The baby immediately started to experience generalized myoclonus ([ Video 1—Part A ]). On suspicion of an epileptic origin, phenobarbital 20 mg/kg was administered, with no success. Cranial ultrasound revealed no bleeding, while electroencephalography showed no epileptiform discharges ([ Fig. 1 ]). Suspecting benzodiazepine-induced myoclonus, flumazenil at 0.01 mg/kg was administered, resulting in cessation of movements in around 15 minutes ([ Video 1—Part B ]). Myoclonus has been reported in neonates after benzodiazepine administration.[ 1 ] [ 2 ] [ 3 ] This phenomenon seems to stem from the developmental activity of the GABA receptor, potentially heightening the vulnerability of preterm infants.[ 2 ] The cessation of movements after flumazenil has been documented in just two other cases.[ 1 ] [ 2 ] Our case provides videographic documentation, enhancing understanding of benzodiazepine-induced myoclonus in neonates. Video 1 In the first part, generalized myoclonias are observed following the administration of lorazepam. The second part shows cessation of abnormal movements following administration of flumazenil. Download Video Fig. 1 EEG showed no epileptiform discharges concurrent with the myoclonus. EEG, electroencephalography. Author Contributions Study conception and design: G.D'O., P.M.; data collection, analysis, and interpretation of results: G.D'O.; draft manuscript preparation: G.D'O. All authors reviewed the results and approved the final version of the manuscript. Publication History Received: 09 May 2024 Accepted: 03 June 2024 Accepted Manuscript online: 05 June 2024 Article published online: 02 July 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".