Neonatal abstinence syndrome due to prenatal levetiracetam exposure

Abstract

  Levetiracetam (LEV) is one of the least teratogenic anticonvulsants with comparatively low mutagenicity and is thus often the first-choice drug for women of childbearing age with epilepsy. While the high breast milk transfer rate of LEV is widely known, much remains unknown about its role as a potential risk factor for neonatal abstinence syndrome (NAS). We experienced two cases in which neonates presenting with NAS were born to mothers receiving LEV treatment. In both cases, no abnormalities in fetal development or pulse monitoring were observed during gestation, and asphyxia did not occur. However, from 1 hour post-birth onward, the two neonates presented with maximum NAS scores of 4 points (lethargy, tachypnea, and poor feeding) and 8 points (lethargy, hypotonia, apnea, and tachypnea), necessitating intensive care, including tracheal intubation. Drug transfer to the fetus during pregnancy is unavoidable even for drugs that are believed to be relatively safe, hence neonates must be monitored carefully. Regardless of the stability of the pregnancy course or the absence of asphyxia, physicians must be aware of the possibility of NAS onset in infants born to mothers taking certain medications. Sufficient preparation for resuscitation and proper management until the stabilization of feeding behavior are necessary.