Evaluation of the efficacy and safety of levetiracetam treatment for neonatal seizures in extremely preterm infants

Abstract

Aim: Levetiracetam (LEV) is increasingly being used to treat seizures in the neonatal period. Data about using LEV in extremely preterm infants with seizures is insufficient and limited with only a handful studies. This study aimed to evaluate the efficacy and safety of LEV in the treatment of seizures in extremely preterm infants.Methods: This retrospective cohort study was conducted on extremely premature newborns, those who were born ≤28 weeks of gestational age, and took their first intravenous dose of levetiracetam due to neonatal seizure before their 44th gestational week between September 2017-February 2019. Loading and maintenance dosage of LEV, previously used antiepileptic medications, response to treatment and side effects of LEV were recorded.Results: Twenty extremely preterm neonates (9 males and 11 females) who received LEV were evaluated. Gestational ages ranged from 23 to 28 weeks, with a median of 26.5 weeks. Birth weights ranged from 520-1210 gr and 15 infants (75%) had extremely low birth weights. For the treatment of seizures, 12 patients (60 %) were initially started on levetiracetam as first-line therapy and eight patients (40%) were administered levetiracetam as a second or third-line antiepileptic drug. The efficiency of seizure control with LEV was 60 % (12/20) in all patients. The median LEV dose at the time seizure control was achieved was 40 mg/kg. No side effects were observed due to LEV treatment. Conclusion: This study shows that LEV can be efficient and safe for seizure management in extremely preterm infants. Seizure control was better achieved when LEV was given as the first-line antiepileptic medication in extremely preterm infants.