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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. 1Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Dublin, Ireland
  2. 2Neonatology, Rotunda Hospital, Dublin, Ireland
  3. 3School 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

https://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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