The National Patient Safety Team identified a report involving an infant who was given a higher than intended dose of midazolam for sedation prior to having an MRI scan, the medication was administered via the intranasal route. 

Injectable preparations of medication for sedation and/or analgesia are sometimes given via the intranasal route instead of as an injection as this can be less invasive and more acceptable to patients and/or their families. Due to a lack of licensed intranasal formulations, off-label use of injectable products to administer intranasal doses is often necessary. Such off-label use is not always included in the BNF for Children clinical resource, and dosing information may therefore not be readily available. 

We communicated our concerns to the Neonatal and Paediatric Pharmacy Group (NPPG) who subsequently published Position Statement 2023-03: Use of Injection Solutions to Administer Analgesics or Sedatives via the Intranasal Route which includes dosing and practical recommendations for dose delivery.