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Guideline aims to streamline simple febrile seizure analysis

Subcommittee on Febrile Seizures. Pediatrics. 2011;127:389-394.

Most simple febrile seizures will not require further evaluation, but pediatricians should consider meningitis, particularly in children who present with any clinical symptoms, according to a guideline published online this week by the AAP’s Subcommittee on Febrile Seizures.

Subcommittee members said clinicians should consider a lumbar puncture in any infant between 6 and 12 months of age “who presents with a seizure and fever, is considered deficient in Haemophilus influenzae type b or Streptococcus pneumoniae immunizations, or when immunization status cannot be determined, because of an increased risk of bacterial meningitis.”

The researchers said because Hib and S. pneumoniae vaccinations are currently in widespread use, “current data no longer support routine lumbar puncture in well-appearing, fully immunized children who present with a simple febrile seizure.”

The subcommittee also advised considering a lumbar puncture for those children who are pretreated with antibiotics.

The researchers discouraged routine use of electroencephalography in otherwise neurologically healthy children and also discouraged routine evaluation with neuroimaging or blood studies, noting that blood studies should be used as part of diagnosis of the fever itself, rather than the seizure evaluation.

The new guideline replaces an earlier AAP guideline from 1996 and is based on a literature review of papers published between 1996 and February 2009, the researchers said.

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