DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20161033

Factors predicting bacterial meningitis in children aged 6-18 months presenting with first febrile seizure

Nahid Khosroshahi, Kamyar Kamrani, Mojdeh Habibi Zoham, Hamidreza Noursadeghi

Abstract


Background: Febrile seizures are the most common form of childhood seizure disorder. Between 2% and 5% of children between the age of 6 and 60 months experience at least one febrile seizure. Most of these febrile seizures are benign and self-limiting. However, some may indicate an underlying pathology like bacterial meningitis. As bacterial meningitis can be the most serious etiology of febrile seizures, we performed a cross sectional study to assess the factors predicting the risk of bacterial meningitis among various subgroups of young children with a first febrile seizure.

Methods: In this cross sectional study, 571 infants aged between 6-18 months presenting with first simple seizure from September 2011 to September 2013 were enrolled. These patients were admitted to the neurology ward of Bahrami Children Hospital, a tertiary children hospital. All clinical data of the patients were analyzed.

Results: Lumbar puncture was performed in 458 out of 571 patients (80.2 %). Bacterial meningitis was evident in 1.1% of patients with first febrile seizures. Eighty percent of children with bacterial meningitis were presented with complex febrile seizures with focal features. Another risk factor predicting bacterial meningitis was duration of postictal drowsiness.

Conclusions: It seems that according to new data describing limited need of performing lumbar puncture in all children with febrile seizure, some predicting factors of bacterial meningitis can be used to prevent unnecessary lumbar puncture. Complex febrile seizures especially those with focal features are the most important predicting factors. Larger prospective studies are needed to assess the presumed conclusion.


Keywords


Febrile convulsion, Lumbar puncture, Bacterial meningitis

Full Text:

PDF

References


Kliegman R, Stanton B, Behrman R. Nelson Textbook of paediatrics, 19th Edition. 2015:1277.

Kimia AA, Capraro AJ, Hummel D, Johnston P, Harper MB. Utility of lumbar puncture for first simple febrile seizure among children 6 to 18 months of age. Pediatrics. 2009;123:6-12.

Baumann RJ, Kao A. Pediatric Febrile Seizures. Medscape Medline, last updated. 2015.

Joffe A, McCormick M, De Angelis C. Which children with febrile seizures need lumbar puncture? Decision analysis approach. Am J Dis Child. 1983;137:1153-6.

Batra P, Gupta S, Gomber S, Saha A. Predictors of meningitis in children presenting with first febrile seizures. Pediatr Neurol. 2011;44:35-9.

American Academy of Pediatrics, Subcommittee on Febrile Seizures. Clinical Practice Guideline – Febrile Seizures: Guideline for the Neurodiagnostic Evaluation of the Child with a Simple Febrile Seizure. Pediatrics. 2011;127:389-94.

Shaked O, Peña BM, Linares MY, Baker RL. Simple febrile seizures: are the AAP guidelines regarding lumbar puncture being followed? Pediatr Emerg Care. 2009;25(1):8-11.

Joshi BR, Rayamajhi A, Mahaseth C. Children with first episode of fever with seizure: is lumbar puncture necessary? JNMA J Nepal Med Assoc. 2008.

Teach SJ, Geil PA. Incidence of bacteremia, urinary tract infection, and unsuspected bacterial meningitis in children with febrile seizures. Pediatr Emerg Care. 1999;15:9-12.

Casasoprana A, Hachon Le Camus C, Claudet I, Grouteau E, Chaix Y, Cances C. Value of lumbar puncture after a first febrile seizure in children aged less than 18 months. A retrospective study of 157 cases. Archives de pediatrie: organe officiel de la Societe francaise de pediatrie. 2013.

Chin Rf, Neville BG, Peckham C. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet. 2006;368(9531):222-9.

Baraff LJ. Management of fever without source in infants and children. Ann Emerg Med. 2000;36:602-14.

Trainor JL, Hampers LC, Krug SE, Listernick R. Children with first time simple febrile seizures are at low risk of serious bacterial illness. Acad Emerg Med. 2001;8:781-7.

Tinsa F, El Gharbi A, Ncibi N, Bouguerra C, Ben AW, Zouari B. Role of lumbar puncture for febrile seizure among infants under one year old. La Tunisie médicale. 2010;88(3):178.

Hom J, Medwid K. The low rate of bacterial meningitis in children, ages 6 to 18 months, with simple febrile seizures. Academic Emergency Medicine. 2011;18(11):1114-20.