Predictors of recurrent febrile seizure in children aged from 6 months to 5 years: A cross-sectional study

Abstract

Objective: To study the clinical profiles of children with febrile seizures, comparing those with single episodes to recurrent cases, and identify predictors of recurrence. In addition, to develop a scoring system to predict recurrence after the first febrile seizure, and identify modifiable risk factors to mitigate recurrence risks.

Methods: This cross-sectional study included children aged 6 months to 5 years with typical febrile seizures, seen as inpatients or outpatients of the Department of Pediatrics at a tertiary care teaching hospital. Data were collected via parent interviews, physical exams, and laboratory tests. The questionnaire covered demographics, antenatal, natal, and postnatal events, seizure history, family history, immunization, daycare attendance, and fever management. Clinical evaluations ruled out central nervous system infections and fever causes were diagnosed per ICD-10 at discharge. Laboratory tests assessed anemia, dyselectrolytemia, and hypoglycemia. Data were analyzed in SPSS Version 25 using descriptive statistics, t-tests, Chi-square tests, and odds ratios with 95% confidence intervals (CI), with significance set at P<0.05.

Results: 451 children were included in this study. Low birth weight (OR=2.60, 95% CI=1.12-6.33, P=0.026), age at first episode <12 months (OR=0.28, 95% CI=0.16-0.48, P>0.001), family history of febrile seizure (OR=5.21, 95% CI=2.92-9.28, P>0.001), no intermittent prophylaxis (OR=15.25, 95% CI=7.05-32.90, P>0.001), treatment for fever (OR=0.26, 95% CI=0.13-0.51) and low socioeconomic status (OR=5.87, 95% CI=3.32-10.38) were significantly associated with recurrent febrile seizures.

Conclusions: Low birth weight, age at first episode ⩽12 months, family history of febrile seizure, no intermittent prophylaxis, inadequate treatment for fever and low socioeconomic status were significant risk factors for having recurrent febrile seizures in children aged from 6 months to 5 years.

Keywords

Febrile seizures / Recurrent / Predictors / Modifiable factors / India

Conflict of interest statement

The authors report no conflict of interest.

Funding

There was no extramural funding received for conducting this study.

Data availability statement

The data supporting the findings of this study are available from the corresponding authors upon request.

Publisher’s note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

[1] Lambertucci JR. Febre. Semiologia médica: As bases do diagnóstico clínico. Rio de Janeiro. Livraria e Editora Revinter 2004;4:66-77.

[2] Vasconcellos MC. Febre, tosse e vômito. Pediatria ambulatorial. Belo Horizonte. COOPMED 2005;4:221-237.

[3] Aydin A, Ergor A, Ozkan H. Effects of sociodemographic factors on febrile convulsion prevalence. Pediatr Int 2008; 50(2):216-220.

[4] Li J, Olsen J, Obel C, Christensen J, Precht DH, Vestergaard M. Prenatal stress and risk of febrile seizures in children: A nationwide longitudinal study in Denmark. J Autism Dev Disord 2009; 39(7):1047-1052.

[5] Annegers JF, Hauser WA, Elveback LR, Kurland LT. The risk of epilepsy following febrile convulsions. Neurology 1979; 29(3):297-303.

[6] Kumar N, Gupta N, Kishore J. Kuppuswamy's socioeconomic scale: updating income ranges for the year 2012. Indian J Public Health 2012; 56(1):103-104.

[7] Offringa M, Hazebroek-Kampschreur AA, Derksen-Lubsen G. Prevalence of febrile seizures in Dutch schoolchildren. Paediatr Perinat Epidemiol 1991; 5(2):181-188.

[8] Hauser WA. The prevalence and incidence of convulsive disorders in children. Epilepsia 1994; 35(Suppl 2):S1-S6.

[9] Annegers JF, Hauser WA, Shirts SB, Kurland LT. Factors prognostic of unprovoked seizures after febrile convulsions. N Engl J Med 1987; 316(9):493-498.

[10] Berg AT, Shinnar S, Shapiro ED, Salomon ME, Crain EF, Hauser WA. Risk factors for a first febrile seizure: A matched case-control study. Epilepsia 1995; 36(4):334-341.

[11] van Stuijvenberg M, Steyerberg EW, Derksen-Lubsen G, Moll HA. Temperature, age, and recurrence of febrile seizure. Arch Pediatr Adolesc Med 1998; 152(12):1170-1175.

[12] Berg AT, Shinnar S, Hauser WA, Leventhal JM. Predictors of recurrent febrile seizures: A meta-analytic review. J Pediatr 1990; 116(3):329-337.

[13] AL-Zwaini EJ, AL-Ani SS, AL-Khalidi MJ, AL-Taie MF. Risk factors for febrile seizures: A matched case control study. IPMJ 2006; 5(3):353-358.

[14] Sun Y, Vestergaard M, Pedersen CB, Christensen J, Basso O, Olsen J. Gestational age, birth weight, intrauterine growth, and the risk of epilepsy. Am J Epidemiol 2008; 167(3):262-270.

[15] Verity CM, Butler NR, Golding J. Febrile convulsions in a national cohort followed up from birth. I--Prevalence and recurrence in the first five years of life. Br Med J 1985; 290(6478):1307-1310.

[16] Nick A, Stowe J, Wise L, Miller E. Post-licensure comparison of the safety profile of diphtheria/tetanus/whole cell pertussis/Haemophilus influenza type b vaccine and a 5-in-1 diphtheria/tetanus/acellular pertussis/Haemophilus influenza type b/polio vaccine in the United Kingdom. Vaccine 2010; 28(44):7215-7220.

[17] Mahyar A, Ayazi P, Fallahi M, Javadi A. Risk factors of the first febrile seizures in Iranian children. Int J Pediatr 2010;2010:862897.

[18] 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(1):17-19.

[19] Knudsen FU. Recurrence risk after first febrile seizure and effect of short-term diazepam prophylaxis. Arch Dis Child 1985; 60(11):1045-1049.

[20] Lewis HM, Parry JV, Parry RP, Davies HA, Sanderson PJ, Tyrrell DA, et al. Role of viruses in febrile convulsions. Arch Dis Child 1979; 54(11):869-876.

[21] Heydarian F, Vatankhah H. The role of anemia in first simple febrile seizure in children aged 6 months to 5 years old. Neurosciences (Riyadh) 2012; 17(3):226-229.

[22] Rutter N, O'Callaghan MJ. Hyponatraemia in children with febrile convulsions. Arch Dis Child 1978; 53(1):85-87.

[23] Rutter N, Smales OR. Calcium, magnesium, and glucose levels in blood and CSF of children with febrile convulsions. Arch Dis Child 1976; 51(2):141-143.