Introduction: Phenobarbital and phenytoin are two FDA approved antiepileptic drugs to treat neonatal seizures and they remain the most common treatment modalities for treating neonatal seizures(1). However, a randomized controlled trial comparing phenobarbital and phenytoin found that greater than 50% of neonates treated with either phenobarbital or phenytoin continued to have evidence of abnormal electrical activity on electroencephalography(2). Furthermore, phenobarbital has a deleterious effect on developing neuronal cells(3). Levetiracetam is a wide spectrum anticonvulsant. Its metabolism does not include CYP P450 system and rapid intravenous administration is not associated with cardiovascular adverse effects(4). Levetiracetam administration after hypoxic ischemia results in a significant decrease in the number of apoptotic cells in the neonatal rat brain(5). All these features make levetiracetam a promising drug for neonatal seizures and many pediatric neurologistsa are using it off-labeling to manage treatment-resistant neonatal seizures

Methods: We did retrospecitve chart review of neonates, who were admitted to neonatal intensive care unit at Kentucky children's hospital form June 2010 to August 2013 and received levetiracetam

Results: Total 11 neonates with electrographic seizures, who received levetiracetam were identified. Levetiracetam was associtaed with seizure reduction in 36% (4 of 11) of neoneates. No adverse effects were reported.

Conclusion/Dicussion: Levetiracetam has a potential to represent safe and effective therapeutic option to treat neonatal seizures. Our study is limited due to the fact that the infants with significant seizure burden, who failed other antiepileptic drugs were exclusively included. Single blind controlled trial comparing convential treatment and levetiracetam is warranted.