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Simple febrile seizures: are the AAP guidelines regarding lumbar puncture being followed?

Oranit Shaked1, Barbara M Garcia Peña, Marc Y R Linares

  • 1Division of Emergency Medicine, Department of Pediatrics, Miami Children's Hospital, Miami, FL 33155, USA. oranit.shaked@gmail.com

Pediatric Emergency Care
|January 1, 2009
PubMed

Insights

Pediatricians are not consistently following guidelines for lumbar puncture (LP) in infants with febrile seizures. Current recommendations may need updating based on modern disease prevalence and causes.

Area of Science:

  • Pediatrics
  • Emergency Medicine
  • Infectious Disease

Background:

  • The American Academy of Pediatrics (AAP) issued guidelines in 1996 recommending lumbar puncture (LP) for infants under 12 months with a first febrile seizure.
  • These recommendations aimed to diagnose meningitis in young children presenting with seizures.

Purpose of the Study:

  • To evaluate adherence to AAP guidelines for LP in infants with febrile seizures.
  • To determine the incidence of meningitis in children undergoing LP for febrile seizures.
  • To assess the impact of patient age and antibiotic pretreatment on LP performance.

Main Methods:

  • A retrospective chart review was conducted at Miami Children's Hospital.
  • The study included 56 infants aged 6-12 months with a first simple febrile seizure.
  • Data were collected between January 2001 and November 2005.

Main Results:

  • Lumbar puncture was performed in 50% of eligible patients.
  • No significant difference in LP performance was observed based on patient age or prior antibiotic use.
  • No cases of meningitis were diagnosed in the study group, with all cerebrospinal fluid cultures remaining sterile.

Conclusions:

  • Adherence to the AAP's 1996 recommendations for LP in simple febrile seizures is suboptimal.
  • The study suggests that current guidelines may not reflect contemporary disease epidemiology and etiologies.
  • Revisiting and updating the AAP practice parameter for febrile seizures is warranted.
Abstract

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