Home › Paediatrics › IM beats intranasal midazolam in paediatric seizures

Paediatrics

IM beats intranasal midazolam in paediatric seizures

Intranasal Versus Intramuscular Midazolam in Pediatric Seizure Control: A Systematic Review and Meta-Analysis
Prehospital Emergency Care · Added 6 May 2026

Meta-analysis testing whether intranasal or intramuscular midazolam works better for paediatric seizures without cannula access — intramuscular midazolam was associated with faster seizure termination and less need for rescue therapy, especially in the prehospital setting.

Study type

Systematic review

Design

Systematic review and meta-analysis (random-effects)

Participants

5 studies, 3,933 paediatric seizure patients (97.9% prehospital)

Main finding

IM midazolam associated with less rescue therapy (RR 1.29; 95% CI 1.15–1.45), shorter time to seizure termination (MD 23.60 s; 95% CI 2.31–44.89), persisting at 0.2 mg/kg dose.

Caveat

Only five studies, observational comparison of routes with possible confounding

Bottom line

Supports current practice

Learning goal

Weigh the benefits and limitations of intranasal midazolam when intramuscular access is unavailable in paediatric seizures.

More

• Topic: Paediatrics
• Daily scan: 6 May 2026

Related papers on Paediatrics

• Poor field differentiation of infant upper vs lower airway disease

  Prehospital Emergency Care · 27 Jul 2026 · Cohort · Context only

  EMS clinicians documented similar primary impressions and administered many of the same treatments across both upper and lower airway groups, demonstrating minimal differentiation in prehospital management of young children.

• Synchronised ventilation faster ROSC in neonatal piglets

  Resuscitation Plus · 27 Jul 2026 · Simulation · Hypothesis-generating

  In a neonatal piglet model of asystolic cardiac arrest, CCSV resulted in a significantly faster time to ROSC compared to 3:1 C:V.

• Observation cuts CT in paediatric abdominal trauma

  Annals of Emergency Medicine · 27 Jul 2026 · Cohort · Supports current practice

  Observation with deferred CT decisionmaking was associated with less frequent CT use, particularly in patients with intermediate clinician suspicion, without an increase in missed injuries.

• Prehospital physicians underconfident in paediatrics

  Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine · 31 May 2026 · Cross-sectional · Context only

  They surveyed emergency physicians and analysed 9,409 protocols to understand pediatric emergency preparedness, and found pediatric cases represent only 6.5% of prehospital physician deployments but physicians reported low confidence in neonatal care, intoxication, and pediatric polytrauma.