Efficacy of Phenobarbital Versus Levetiracetam in Neonatal Seizures: Impact on EEG Results and Clinical Recovery

Articles in Press

Document Type : Original Article

Authors

1 Departement of Pediatric, Universitas Sumatera Utara

2 No one

10.22038/ijn.2026.89357.2730

Abstract

Objective: To compare the efficacy of phenobarbital versus levetiracetam in treating neonatal seizures, focusing on EEG normalization, seizure control, and neurodevelopmental outcomes.

Patients and Methods: A retrospective cohort study was conducted involving 59 neonates aged 0–28 days admitted to a tertiary NICU with clinically or EEG-confirmed seizures between January 2022 and February 2025. Patients received phenobarbital, levetiracetam, or combination therapy. Outcomes included seizure control within 24 hours, EEG normalization during follow-up, and neurodevelopmental status.

Results: Seizure control within 24 hours was achieved in 94.6% of cases, with 100% control in the levetiracetam group. EEG normalization occurred in 58.3% of patients in the levetiracetam group, 42.9% in the phenobarbital group, and 43.8% in the combination group (p = 0.537). Normal neurodevelopmental outcomes were seen in 100% of the levetiracetam group, compared to 88.9% and 87.5% in the phenobarbital and combination groups, respectively.

Conclusions: Levetiracetam demonstrated comparable efficacy to phenobarbital in seizure control and EEG normalization, with a trend toward superior neurodevelopmental outcomes. These findings support its use as a first-line antiseizure medication in neonates.

Keywords

Iranian Journal of Neonatology

Articles in Press, Accepted Manuscript
Available Online from 10 June 2026

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