Is iron deficiency anaemia a risk factor for febrile seizure? A case control study


  • Poonam Singh Department of Pediatrics, SMIMER, Surat, Gujarat
  • Vinit Mehta Department of Pediatrics, SMIMER, Surat, Gujarat



Febrile convulsions, Iron deficiency anaemia


Background:The relationship between iron deficiency anaemia and febrile convulsions has been examined in several studies with conflicting results. The authors aimed to evaluate the relation, if any, of iron status with febrile seizures.

Methods: In this case-control study, 36 cases and 36 controls were taken. The study group consisted of all children with a diagnosis of febrile convulsion, aged between 6 months and 6 years, without developmental delay, neurological deficit, or CNS infection, who were treated at SMIMER Hospital, a tertiary care centre of Surat, India, from November 2014 to November 2015. The control group consisted of febrile children without convulsion; controls were matched to the cases by gender and age. Sample size was calculated by using SPS based on the alpha error 5%, beta error 10%, power of the study = 90% and using the case (29.5±21.3) and control (53.3±37.6) from previous study. Provided sample size n = 72, where n1 (cases) = 36 and n2 (controls) = 36. Discrete variables expressed as counts (%) and compared using the chi-square tests. Continuous variables are expressed as mean±S.D. and compared by means of the unpaired, two-sided t-test. Adjusted odds ratios and 95% Wald confidence intervals were calculated.

Results:Mean age of patients and controls were 27.33±14 and 27.2±18.7 months respectively. Risk factors like prematurity, prior history of febrile convulsions and family history of convulsions showed statistical significance (p value being 0.001, 0.003 and 0.011) among cases. Serum ferritin levels in study group was found to be 57.10±42.8 microgm/L compared to 135.42±15 microgm/L of control group and it was the only haematological variable which was statistical significance (p-value  0.04). IDA was found in 30.6% of cases and 8.3% of controls (p value 0.0172).  A patient with febrile seizures was 2.4 times more likely to have IDA. (Crude odd ratio 2.4; 95% CI 39.5-40.52).

Conclusions: The study found positive association between iron deficiency anaemia and febrile seizures.  


Kliegman, Stanton, Geme, Schor, Behrman. Iron Deficiency Anaemia. In Nelson Textbook of Pediatrics, 19th edition. Elsevier, Philadelphia. 2015:1655-1658.

Frantzen E, Buchthal LM, Nygaard A, Stene J. A genetic study of febrile convulsions. Neurology. 1970;20:909-17.

Annegers JF, Hauser WA, Elveback LR, Kurland LT. The risk of epilepsy following febrile convulsions. Neurology. 1979;29:297-303.

Hauser WA, Annegers JF, Anderson VE, Kurland LT. The risk of seizure disorders among relatives of children with febrile convulsions. Neurology. 1985;35:1268-73.

Tsuboi T. Febrile convulsions. VE Anderson, WA Hauser, JK Penry In Genetic basis of the epilepsies. Raven Press, New York. 1982:123-134.

Green SM, Rothrock SG, Clem KJ, Zurcher RF, Mellick L. Can seizures be the sole manifestation of meningitis in febrile children? Pediatrics. 1993;92:527-34.

Vestergaard M, Christensen J. Register-based studies on febrile seizures in Denmark. Brain Dev. 2009;31:372-7.

Klein NP, Fireman B, Yih WK, Lewis E, Kulldorff M. Measles, mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics. 2010;126:1-8.

Ganesh R, Janakiraman L. Serum zinc levels in children with simple febrile seizure. Clin Pediatr (Phila). 2008;47:164-6.

Shinnar S, Glauser TA. Febrile seizures. J Child Neurol. 2002;17(1):44-52.

Hampers LC, Spina LA. Evaluation and management of pediatric febrile seizures in the emergency department. Emerg Med Clin North Am. 2011;29:83-93.

Sfaihi L, Maaloul I, Kmiha S, Aloulou H, Chabchoub I. Febrile seizures: an epidemiological and outcome study of 482 cases. Childs Nerv Syst. 2012;28:1779-84.

Pisacane A, Sansone R, Impagliazzo N, Coppola A, Rolando P, D’apuzzo A, et al. Iron deficiency anaemia and febrile convulsions: case-control study in children under 2 years. BMJ. 1996;313(7053):343.

Kobrinsky NL, Yager JY, Cheang MS, Yatscoff RW, Tenenbein M. Does iron deficiency raise the seizure threshold? J Child Neurol. 1995;10(2):105-9.

Rehman N, Billoo AG. Association between iron deficiency anemia and febrile seizures. J Coll Phys Surg Pak. 2005;15(6):338-40.

Millichap GJ. Iron insufficiency as a risk factor for febrile seizures. AAP Grand Rounds. 2002;8(6):62-3.

Vaswani RK, Dharaskar PG, Kulkarni S, Ghosh K. Iron deficiency as a risk factor for first febrile seizure. Indian Pedia. 2009;47(5):437-9.

Criteria for defining iron deficiency anaemia in a febrile child: WHO Geneva 2001, Available at Accessed on 6 December 2015.

Daoud AS, Batieha A, Ekteish F, Gharibeh N, Ajlouni S, Hijazi S. Iron status: a possible risk factor in first febrile seizure. Epilepsia. 2002;43(7):740-3.

Kumari PL, Nair MK, Nair SM, Kailas L, Geetha S. Iron deficiency as a risk factor for simple febrile seizures a case control study. Indian Pediatr. 2012;49:17-9.

Bidabadi E, Mashouf M. Association between iron deficiency anemia and first febrile convulsion: a case–control study. Seizure. 2009;18:347-51.

Yousefchaijan P, Eghbali A, Rafeie M, Sharafkhah M, Zolfi M, Firouzifar M, et al. The relationship between iron deficiency anaemia and simple febrile convulsion in children. J Pediatr Neurosci. 2014;9(2):110-4.

Srinivasa S, Reddy SR. Iron deficiency anaemia in children with febrile seizures a cohort study. Curr Pediatr Res. 2014;18(2):95-8.

Sadeghzadeh M, Khoshnevis P, Mahboubi E. Iron status and febrile seizure- a case control study in children less than 3 years. Iran J Child Neurol. 2012;6(4):27-31.

Gupta S, Agarwal N, Maheshwari M. Iron deficiency anaemia as a risk factor for febrile seizures a case control study. People’s J Scientific Res. 2015;8(2):37-40.

Fallah R, Tirandazi B, Golestan M. Iron deficiency anaemia in children with febrile seizure. Iran J Ped Hematol Oncol. 2012;3(1):21-4.

Idro R, Gwer S, Williams TN, Otieno T, Uyoga S, Fegan G, et al. Iron deficiency and acute seizures: results from children living in rural Kenya and a meta-analysis. PLOS One. 2010;5(11):14001.

Mangal A, Kumar V, Panesar S, Talwar R, Raut D, Singh S. Updated BG prasad socioeconomic classification. Indian J Public Health. 2015;15(1):42-4.

American academy of paediatrics. Provisional committee on quality improvement and subcommittee on febrile seizures. practice parameters: the neurodiagnostic evaluation of child with first simple febrile seizures. Paediatrics. 1996;97(5):769-72.

Criteria for defining iron deficiency anaemia in febrile child: WHO Geneva 2001, Available at Accessed on 6 December 2015.






Original Research Articles