Hooper RG, Ramaswamy VV, Wahid RM, et al. - In this systematic review and meta-analysis, researchers tested the safety and efficacy of levetiracetam, a second-generation antiseizure medication approved for seizures in adults and children older than 1 month but not neonates, when used as a first-line treatment of neonatal seizures. From the beginning through November 20, 2020, four electronic databases, Medline, Embase, Web of Science, and ClinicalTrials.gov, were thoroughly searched. Fourteen studies evaluating 1,188 neonates were involved: four randomized controlled trials, three observational trials with phenobarbital as the control arm, and seven observational studies of levetiracetam with no control arm. The lack of certainty in the evidence suggests that levetiracetam may not be more effective than phenobarbital. According to evidence with moderate certainty, levetiracetam is associated with a lower risk of adverse events.