Masters Degrees (Paediatrics and Child Health)

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Browsing Masters Degrees (Paediatrics and Child Health) by Subject "American Academy of Paediatrics guidelines for simple febrile seizures"

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    The role op lumbar puncture in young infants with seizures and fever in a resource-constrained setting
    (Stellenbosch : Stellenbosch University, 2016-12) Coetzee, Ashton; Smit, Liezl; Solomons, Regan; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH SUMMARY: Background Differentiating febrile seizures from serious infections like bacterial meningitis is essential but remains a clinical dilemma for many clinicians. This has lead to local guidelines advocating routine lumbar puncture (LP) in all infants less than 18 months of age presenting with fever-associated seizures irrespective of clinical findings. Recently revised American Academy of Pediatrics (AAP) guidelines for simple febrile seizures (SFS) recommends a LP only if there are ‘clinical signs or symptoms of concern’. This guidance can however not necessarily be extrapolated to resource-constrained settings as studies chosen to inform these guidelines have deliberately excluded studies from developing countries. This study aim to evaluate the utility and outcome of LP, as a special investigation, in infants between the ages of 6 months and 18 months, presenting with seizures and associated fever, in a setting with uncertain immunization coverage and high burden of malnutrition, HIV and TB. Methodology A retrospective cohort review was conducted of infants aged 6 to 18 months admitted with fever and seizures to the Paediatric Emergency & Ambulatory unit at Tygerberg Children’s Hospital over a 12 month period. Patients were identified using the admission records, patient admission notes and laboratory CSF results. Descriptive statistics was performed on demographic outcome variables. Univariate analysis for continuous variables were performed to determine adjusted associations between historical and/or clinical findings and CSF results. Results Fever and associated seizures were the presenting feature in 25% of infants between the ages of 6 to 18 month in our study. Infants included in our study were mostly well, with normal growth and development, none were HIV-infected and only 10% exposed to a known TB case. Immunizations were complete for age in 79% of infants. 62/84 (74%) of the infants eligible for the study underwent a lumbar puncture. The majority of infants were diagnosed as Febrile Seizures (75/84, 89%). Viral upper respiratory infection was the most common cause for fever (63%) in these infants. A clear source of fever was found to be statistically significant in differenciating between patients with normal and abnormal CSF results (p< 0.001). Meningitis was diagnosed in 6/84 (7%) of infants; of whom 3 had abnormal neurological findings suggestive of meningitis at presentation. Based on CSF results, 3/62 (5%) were diagnosed as viral meningitis, 1/62 (2%) as tuberculous meningitis and 2/62 (3%) as presumed bacterial meningitis. No cases of meningitis were diagnosed in infants fulfilling the case definition of Simple Febrile Seizures in this study. Three children (3%) presenting with Complex Febrile Seizures and normal neurological findings were diagnosed and treated as meningitis (1 viral, 2 bacterial) following a LP. Conclusion Fever with associated seizures in infants between the ages of 6 to 18 month presented a significant burden of disease in our emergency unit; and underlines the need for evidence-based management guidelines. If American Academy of Pediatrics (AAP) guidelines for SFS had been applied to our study population, all cases of serious illness would have been investigated and identified. AAP guidelines could thus be applied to well infants between the ages of 6 and 18 months in resource-constrained settings; decreasing the use of LP with associated cost savings. Larger studies are required to identify clinical variables to guide best practice, especially in infants presenting with complex febrile seizures.