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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
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 …
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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