Should levetiracetam rather than phenobarbitone be the first-line treatment for neonatal seizures?

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