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Should levetiracetam rather than phenobarbitone be the first-line treatment for neonatal seizures?
  1. Sheiniz Giva1,
  2. Michael A Boyle2,
  3. Kathleen M Gorman1,3
  1. 1 Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Dublin, Ireland
  2. 2 Neonatology, Rotunda Hospital, Dublin, Ireland
  3. 3 School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
  1. Correspondence to Dr Kathleen M Gorman, Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Dublin D01 YC67, Ireland; kathleen.gorman{at}cuh.ie

http://dx.doi.org/10.1136/archdischild-2020-320311

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    Scenario

    A male infant was born at 39 weeks’ gestation by spontaneous vaginal delivery. The mother was a 32-year-old primigravida. Antenatal course was uneventful. Apgar score was 9 at 1 min and 10 and 5 min. He did not require resuscitation and was transferred to the postnatal ward with the mother. At 30 hours of age, he developed right arm and leg jerking. A bedside cranial ultrasound suggested a left middle-cerebral artery territory infarct.

    Given the frequent use of levetiracetam in paediatric seizures with a good effect, should this drug be used as first-line in the treatment of neonatal seizures?

    Structured clinical question

    1. In neonates diagnosed with seizures, is there evidence to support levetiracetam rather than phenobarbitone as the first-line treatment of neonatal seizures?

    Search

    Primary sources

    MEDLINE, PubMed, Embase and TRIP were searched using the following search terms:

    (Neonat* [neonate, neonates, neonatal] OR newborn) AND (Levetiracetam OR Keppra) AND (Seizure OR epilepsy OR convulsion)

    (Neonat* [neonate, neonates, neonatal] OR newborn AND (Phenobarb [phenobarbitone, phenobarbital]) AND (Seizure OR epilepsy OR convulsion)

    Secondary sources

    The Cochrane Library was searched using a combination of the terms as …

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    Footnotes

    • Twitter @mijkboyle, @lilkatg

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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