Published date: Sep 26 2019

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 14 (2019), Issue No. 3

Pages: 162–171

DOI: 10.18502/sjms.v14i3.5216

Nader Mutwakel OsmanDepartment of paediatric and Child Health , Fuculty of Medicine

James Peter Garkuoth GaiMohamed Al Amin Hamid Paediatric Hospital Omderuman

The routine investigation of doing lumbar puncture in patient with febrile convulsion is increasing practiced in many hospital.

Objectives:

The aim of this study was to assess the necessity of routine lumbar puncture (LP) to diagnose meningitis in children who present with fever and convulsions.

 Methods:

This is an observational, cross-sectional, hospital-based study, carried out in Mohammed AL-Amin Hamid pediatrics hospital-Omdurman Sudan, during the period from the first of January through 31 July 2018. It involved all (146) children aged 5 months to 6years , who presented with fever and convulsions, undergone lumbar puncture, and  parents signed  written informed consents. Children with known neurological diseases were excluded from this study. Data collected included, age, gender, convulsions type and duration, post-ictal state, routine vaccination status, general condition, recent antibiotics use, past history of fever and convulsions, temperature degree, signs of meningeal irritation, and conscious level. Data were analyzed by Statistical Package for Social Sciences (SPSS) version 23.

Results:

The result revealed that total number of 146 children, male were 62% (n=91), female were 38% (n=55).  5-11 months  35.6% (n=52)  1-3years 43.8% (n=64), and 4-6 years 20.6% (n=30). About 80% of the patients were younger than 4 years of age.  Convulsion was generalized in 97.9%, lasted less than  15 minutes in 99.3%, spontaneously aborted in 94.5%, post-ictal state was brief in 88.4%, first attack in 98.6%, and there was no family history in 97.3%,p=0.000. There was no neck stiffness and photophobia in 92.5% and 98.6% respectively, p=0.000. Patients general condition were well in 76.7% and toxic in 23.3%. Cerebrospinal fluids (CSF) color was clear in 97% and turbid in 3% of patients. CSF white cells was less than  5 in 93.8%, and CSF sugar and protein were normal in 97.3% and 96.6 % respectively, p=0.000. CSF culture was negative for all patients, and almost all (97%, n=141) of the patients were diagnosed as febrile convulsions and sent home, compared to 3% (n=5) who were diagnosed clinically as meningitis.

Conclusion:

This study revealed that, CSF culture was negative for all patients, and almost all were diagnosed as febrile convulsions. However, 5 patients were diagnosed clinically as meningitis. Hence, this findings, challenge the routine lumbar puncture in children who present with fever and convulsion.

[1] Pearce JM. Walter Essex Wynter, Quincke, and lumbar puncture. J Neurol Neurosurgery Psychiatry. 1994; 57(2):179.

[2] Medscape/meningitis

[3] Nelson’s textbook of pediatric 19th edition. 2090/2610

[4] Kimia AA, et al. Yield of lumbar puncture among children who present with their first complex febrile. Pediatrics.2010;126(1): 62-69

[5] Erin M. Fletcher and GhazalaSharieff. West J Emerg Med. May 2013; 14(3): 206-211.

[6] Gontko-Romanowska K et al.: The assessment of risk factors for febrile seizures in children. NeurolNeurochir Pol. 2017 Nov - Dec; 51(6):454-458. doi: 10.1016/j.pjnns.2017.07.011. Epub 2017 Jul 31

[7] Subcommittee on, American A. Neurodiagnostic evaluation of the child with a simple febrile seizure.Pediatrics.2011; 127 (2): 389-384.

[8] Sudanese management protocol for pediatric emergencies, 3rd edition, 2015.28 /176

[9] Mohammad M Attarpour et al. Iran J Microbiol. 2014 Aug; 6(4): 211-218.

[10] IPUMS-DHS (Demographic and health surveys

[11] WHO- Sudan first to introduce life-saving meningococcal type a vaccine into routine immunization.

[12] Wahl B, et al. Lancet Global Health.2018)

[13] Guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children. Updated Dec. 2018

[14] Ghotbi F, et al. An assessment of the necessity of lumbar puncture in children with seizure and fever J Pak Med Assoc. 2009

[15] Reet S, et al. Pediatrics in Review. August 2013, vol.34/Issue 8.

[16] Reet S, et al. Pediatrics in Review. August 2013, vol.34/Issue 8.

[17] Kimia AA, et al. Utility of lumbar puncture for first simple febrile seizure among children 6 to 18month of age. Pediatrics.2009

[18] Guedj R, et al. Acad Emerg Med. 2015

[19] Hom J, et at. Acad Emerg Med. 2011

[20] Najaf-Zadeh et al. Risk of bacterial meningitis in young children with a first seizure in the context of fever: A systemic review and meta-Analysis

[21] Laman M, et al. Cli Infect Dis. 2010

[22] Casasoprana A, et al. Value of lumbar puncture after a first febrile seizure in children aged less than 18months. Arch pediatr 2013 involving 157 children

[23] Azita TAVASOLI et al. Frequency of meningitis in children presenting with febrile seizures. Iran J child neurol. 2014 Autumn;8(4): 51-56

[24] WHO recommendations 2015.