[Role of lumbar puncture for febrile seizure among infants under one year old].
BACKGROUND
Febrile seizure is a frequent cause of hospitalization. Its management remains problematic. According to the American Academy of Pediatrics, lumbar puncture, which is not devoid of risk, is strongly recommended in infants under 1 year.


OBJECTIVE
to define the utility of lumbar puncture in the management of febrile seizures in infants under 12 months and to identify risk factors of meningitis and to respond to this question: "lumbar punction should be done in which infant with febrile seizure?"


METHODS
This retrospective study was conducted in the department of pediatrics B in the Children Hospital of Tunis on eight-year period (2000-2008). In all statistical tests, significance level was set at 0.05.


RESULTS
One hundred and six cases were collected during the period of study. Seizures related to bacterial meningitis were seen in 11 cases (10%). We have separated two groups: GI infants presented bacterial meningitis, and G2 infants with febrile seizure. The comparison between the two groups G1 and G2 showed the following predictors factors of meningitis: age < or = 7 months (p = 0.035), partial seizure (p = 0.028), duration of seizure > 5 min (p < 0.001), recurrence of seizure in the same day(p = 0,006), neurological abnormalities p < 0.001), CRP > 20 mg/l (p = 0.03), hyponatremia < or = 125 mmol/l (p = 0.01). The risk of meningitis is very low: 3.1 x 10 -3, if this condition is met: infants older than 7 months, having a unique and short seizure < or = 5 min, and with a CRP < or = 20mg/l.


CONCLUSIONS
If the infant is older than 7 months, presenting a unique, febrile and short (< or = 5 min) seizure, having a normal neurological examination with CRP < or = 20 mg/l, lumbar puncture should be discussed a case by case but an hospitalization for 24 hours is required for monitoring.
Tinsa
Faten
F
Service de médecine infantile B, hôpital d'Enfants de Tunis, Place Bab saadoun Jabbary, Tunis, Tunisie.
El Gharbi
Ahmed
A
Ncibi
Nesrine
N
Bouguerra
Chaker
C
Ben Aissia
Wafa
W
Zouari
Béchir
B
Boussetta
Khadija
K
Bousnina
Souad
S
D000367:Age Factors; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis*; D015999:Multivariate Analysis; D012008:Recurrence; D012189:Retrospective Studies; D003294:Seizures, Febrile / Q000150:complications*; D013129:Spinal Puncture; D013997:Time Factors
D002097:C-Reactive Protein