Assessment of knowledge and practice of pediatric residents towards using and efficacy of levetiracetam as treatment for neonatal seizure

Background: Seizures are a common neurologic complication in neonates, with severity ranging from mild to life-threatening. Despite their prevalence, clinical management guidelines are lacking. Levetiracetam has demonstrated efficacy and safety in older patients, which has spurred interest in its use for neonates. The awareness and understanding of antiepileptic drugs by physicians are crucial for effective management.

Aim: This study aims to evaluate the knowledge and practices of pediatric residents regarding the use of Levetiracetam in treating neonatal seizures.

Methods: We conducted a cross-sectional study involving 257 pediatric residents in Khartoum state from January to May 2021. Participants completed an online Google Form questionnaire, which included questions about their data, current practices in treating neonatal seizures, their use of Levetiracetam, and their knowledge of this drug.

Results: Of the 257 pediatric residents surveyed, 178 (69.3%) were females and 79 (30.7%) were males. The majority were aged 20-30 years (n=128; 49.8%) and were in their fourth year of residency (n=108; 42%). Nearly all participants (n=255; 99.2%) had observed or managed neonatal seizures. Most residents (n=193; 75.1%) used phenytoin as their first-line treatment for neonatal seizures. A total of 201 (78.2%) reported using Levetiracetam for treating neonatal seizures, often in combination with phenytoin (n=65; 25.3%) or phenobarbitone (n=60; 23.4%). Regarding Levetiracetam, 164 (63.8%) residents felt it had a slow onset and took time to stop seizures. Most participants (n=158; 61%) had poor knowledge of Levetiracetam. Common gaps included understanding its protein binding (65%), mechanism of action (68.5%), and indications (80.2%). Better knowledge levels were associated with male residents (P=0.024), those older than 40 years (P=0.037), residents in their third or fourth year (P=0.000), and those working in tertiary hospitals (P=0.042).

Conclusion: Most residents used phenytoin as their primary treatment for neonatal seizures and frequently combined it with Levetiracetam, often alongside phenobarbitone. Despite this, respondents generally had poor knowledge of Levetiracetam. Better knowledge was linked to being male, older age, advanced residency level, and working in tertiary hospitals.