title: Acute meningitis among infants and toddlers with febrile seizures: time for a reappraisal of the value of a lumbar puncture.
abstract: BACKGROUND
  Since clinical signs of meningeal irritation in infants may be absent or misleading, the American Academy of Pediatrics in 1996 recommended that a lumbar puncture be performed in young children following a febrile seizure. Recent evidence supports a conservative approach in children who do not look ill at the time of the physician's assessment. Moreover, seizures as the presenting or sole symptom of bacterial meningitis are very rare.
  
  
  OBJECTIVE
  To assess physicians' compliance with the Academy's recommendations and to determine the incidence of meningitis among febrile seizure patients, including those who did not undergo the puncture.
  
  
  METHODS
  We conducted a retrospective analysis of the number of punctures obtained in febrile seizure patients aged 6-24 months, focusing on the clinician's indications for performing the procedure and on the clinical course of children who did not undergo the puncture.
  
  
  RESULTS
  Among 278 patients (84% simple febrile seizure), 52 (18.7%) underwent the procedure. It was performed in 38% of 45 complex febrile seizure cases and in 48% of 91 infants younger than 12 months of age. Aseptic meningitis occurred in two infants, both with post-ictal apathy. Bacterial meningitis was not found and in none of the patients who did not undergo the puncture was meningitis later diagnosed.
  
  
  CONCLUSIONS
  Compliance with the Academy's recommendations was low, as emergency room physicians based their decision whether to obtain a lumbar puncture solely on clinical grounds. No case of bacterial meningitis was detected among 278 young children with a febrile seizure, including those who did not undergo the puncture.
authors.affiliation: Child Neurology Unit, Meir Medical Center, Kfar Saba, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. nathan.watemberg@clalit.org.il
authors.forename: Nathan
authors.initials: N
authors.lastname: Watemberg
authors.forename: Ifat
authors.initials: I
authors.lastname: Sarouk
authors.forename: Pinchas
authors.initials: P
authors.lastname: Fainmesser
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008581:Meningitis / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D003294:Seizures, Febrile / Q000209:etiology*; D013129:Spinal Puncture