DOI: https://doi.org/10.36347/sjams.2026.v14i07.009

Pages: 1054-1059

Background: Neonatal seizures are the most common neurological emergency, with higher risk in preterm than term neonates, mostly due to hypoxic-ischemic encephalopathy. Levetiracetam may be a safe alternative for treating seizures in preterm neonates. This study aimed to compare the effectiveness and adverse effects of Levetiracetam versus Phenobarbitone in preterm neonates with seizures due to perinatal asphyxia. Methods: This randomized controlled trial was conducted at Bangladesh Shishu Hospital and Institute from June 2020 to July 2022 among preterm neonates (31st to <37 weeks gestational age) with seizures due to perinatal asphyxia. Of 100 enrolled neonates, 72 were randomized into two groups of 36 each. The study group received intravenous Levetiracetam 20 mg/kg loading followed by 10 mg/kg 12-hourly maintenance, while the control group received Phenobarbitone 20-40 mg/kg loading and 2.5 mg/kg/dose 12-hourly maintenance as first-line therapy. Primary outcomes included time to seizure control, adverse effects within 2 hours, length of hospital stay, and need for more than one anticonvulsant. Results: The two groups did not differ statistically for age, sex, weight. Male neonates were affected more than female (61.1 % male in group A and 63.9 % male in group B). Seizure control is significantly higher in Levetiracetam in comparison to Phenobarbitone group (72.22% vs 44.44%). Need for more than one drug was significantly lower in Levetiracetan group (p = 0.004). Length of hospital stay was shorter and adverse effects were found significantly (p = 0.024) lower in Levetiracetam group (5.56 % vs 27.78 %). No serious adverse effect was observed in any group. Conclusion: In the present study, Levetiracetam is more effective and safer than Phenobarbitone in the treatment of seizure in preterm neonate due to perinatal asphyxia.