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Superior seizure control with first-line levetiracetam in very low birth weight neonates: a 10-year comparative

Coşkun Armağan1, Begüm Nişancı Öğünçlü2, Mustafa Halk3

  • 1Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Dokuz Eylül University, Izmir, Türkiye.

Drug Metabolism and Personalized Therapy
|May 27, 2026
PubMed

Insights

Levetiracetam (LEV) is more effective than phenobarbital (PB) for treating neonatal seizures in very low birth weight (VLBW) infants. LEV shows better seizure control and may be a preferred first-line treatment for this vulnerable population.

Area of Science:

  • Neonatal Neurology
  • Pediatric Epilepsy
  • Pharmacology

Background:

  • Very low birth weight (VLBW) infants face high risks of neonatal seizures.
  • Phenobarbital (PB) has been a traditional treatment but has concerns regarding efficacy and neurotoxicity.
  • Levetiracetam (LEV) is emerging as a potential alternative for neonatal seizure management.

Purpose of the Study:

  • To compare the efficacy and safety of levetiracetam (LEV) versus phenobarbital (PB) as first-line antiseizure medications (ASMs) in VLBW infants.
  • To evaluate treatment outcomes and identify factors influencing response to initial ASM therapy in this population.

Main Methods:

  • Retrospective cohort study of 103 VLBW infants treated for seizures between 2013 and 2023.
  • Analysis of medical records, comparing LEV (n=27) and PB (n=76) as initial treatments.
  • Inclusion of data on gestational age, birth weight, seizure type, EEG findings, and treatment response.

Main Results:

  • Levetiracetam (LEV) demonstrated significantly higher efficacy, with fewer infants unresponsive to initial treatment (14.8%) compared to phenobarbital (PB) (56.6%; p<0.001).
  • Lower gestational age was a significant predictor of unresponsiveness to PB.
  • While the LEV group had a higher proportion of infants with severe comorbidities, baseline characteristics were otherwise comparable.

Conclusions:

  • Levetiracetam (LEV) is more successful than phenobarbital (PB) in achieving clinical seizure control as a first-line ASM in VLBW infants.
  • LEV may be a preferred first-choice ASM, particularly for VLBW neonates, pending further prospective validation.
  • LEV's potential for fewer side effects warrants its consideration in clinical treatment algorithms.
Abstract

Keywords:
levetiracetamphenobarbitalseizurevery low birth weight (VLBW)

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