G216(P) A 5-year experience of using levetiracetam, (keppra) to control neonatal seizures in a regional neuroscience nicu

Abstract

Introduction Neonatal seizures are relatively common and are predictors of long-term neurocognitive and developmental impairment. The incidence of seizures in term infants is 1–3 per 1000 live births and is higher in preterm infants at 1%–13%. Aim To study the efficacy of Levetiracetam when used as part of a treatment protocol for neonatal seizures. Methods We reviewed electronic and patient care records of all neonates admitted to our NICU with seizures between 1 st January 2013 and 1 st 2018 January. Seizures were confirmed by single-channel amplitude integrated EEG and/or 12 channel [modified 10–20 system] l EEG in all cases. Results Over a 5 year period we had 5732 admissions to the neonatal unit and 134 patients with seizures. Of these 30 babies were treated with Levetiracetam. The local neonatal seizure treatment protocol includes, in ascending order, first: Phenobarbital® Midazolam® Levetiracetam ® Phenytoin. In babies, clinical seizure activity resolved within 3–48 hours. Levetiracetam used as the first line in 1 patient (no effect), as the second line in 3 patients (2 resolved, 1 later diagnosed with Pyridoxine-dependent seizures). Levetiracetam used as the third line in 21 patients of which 17 patient had good resolution. The four babies who did not respond had the following aetiologies: cerebral infarction, mitochondrial disorder, neonatal hypoglycemia, HIE grade 3 and meconium aspiration. Levetiracetam was used as a fourth line in 5 neonates and had good resolution in all cases. Levetiracetam was not started on one baby who had a diagnosis of pyridoxine-dependent seizure and this baby responded well to pyridoxine. 30 babies treated with Levetiracetam seizure control attained soon after its use in 24 babies (80%). See table 1. Conclusion Based on our single centre experience Levetiracetam achieves good seizure control in neonatal babies and there were no reported side effects noted. Levetiracetam might be considered as a first line treatment in neonatal seizure management when it is appropriate.1 Reference J Pediatr Neurosci. 2017 Jan-Mar;12(1):24–28.