title: Risk of Bacterial Meningitis in Children 6 to 11 Months of Age With a First Simple Febrile Seizure: A Retrospective, Cross-sectional, Observational Study.
abstract: OBJECTIVE
  National and international guidelines are very heterogeneous about the necessity to perform a lumbar puncture (LP) in children under 12 months of age with a first simple febrile seizure. We estimated the risk of bacterial meningitis in children aged 6 to 11 months with a first simple febrile seizure.
  
  
  METHODS
  This multicenter retrospective study was conducted in seven pediatric emergency departments (EDs) in the region of Paris, France. Visits of patients aged 6 to 11 months for a first simple febrile seizure from January 2007 to December 2011 were analyzed. Bacterial meningitis was sequentially sought for by 1) analyzing bacteriologic data at the time of the visit, 2) looking for data from a second visit to the hospital after the index visit, and 3) phone calling the child's parents to determine the symptom evolution after the index visit. Infants lost to this follow-up were searched for in a national bacterial meningitis database.
  
  
  RESULTS
  From a total of 1,183,487 visits in the seven pediatric EDs, 116,503 were for children 6 to 11 months of age. From these, 205 visits were for a first simple febrile seizure. An LP was performed in 61 patients (29.8%). The outcome bacterial meningitis was ascertainable for 168 (82%) visits. No bacterial meningitis was found among these patients (95% confidence interval = 0% to 2.2%). None of the 37 infants lost to our follow-up were registered in the national database as having bacterial meningitis.
  
  
  CONCLUSIONS
  Among children between 6 and 11 months of age with a first simple febrile seizure, the risk of bacterial meningitis is extremely low. These results should encourage national and international societies to either develop or endorse guidelines limiting routine LP in these infants and contribute to widely homogenized management practices.
authors.affiliation: Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Pierre et Marie Curie University, Paris, France.|INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemilogy Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Guedj
authors.affiliation: Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Pierre et Marie Curie University, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Chappuy
authors.affiliation: pediatric emergency department, Robert Debre Hospital, Paris, France.
authors.forename: Luigi
authors.initials: L
authors.lastname: Titomanlio
authors.affiliation: Pediatric Emergency Department, Jean Verdier Hospital, Bondy, France.
authors.forename: Thanh-Van
authors.initials: TV
authors.lastname: Trieu
authors.affiliation: Pediatric Emergency Department, Centre Intercommunal de Creteil, Creteil, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: Biscardi
authors.affiliation: Pediatric Department, Marne la Vallée Hospital, Jossigny, France.
authors.forename: Gisèle
authors.initials: G
authors.lastname: Nissack-Obiketeki
authors.affiliation: Pediatric Emergency Department, Poissy Hospital, Poissy, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Pellegrino
authors.affiliation: Pediatric Department, Versailles Hospital, Le Chesnay, France.
authors.forename: Oussama
authors.initials: O
authors.lastname: Charara
authors.affiliation: Pediatric Emergency Department, Necker-Enfants Malades Hospital, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Angoulvant
authors.affiliation: Pediatric Neurology department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Pierre et Marie Curie University, Paris, France.
authors.forename: Thierry Billette De
authors.initials: TB
authors.lastname: Villemeur
authors.affiliation: Clinical Research Center, Centre Intercommunal de Creteil, Creteil, France.|ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Levy
authors.affiliation: Clinical Research Center, Centre Intercommunal de Creteil, Creteil, France.|ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France.
authors.forename: Robert
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Pierre et Marie Curie University, Paris, France.
authors.forename: Jean Baptiste
authors.initials: JB
authors.lastname: Armengaud
authors.affiliation: Pediatric Emergency Department, Assistance Publique des Hôpitaux de Paris, Armand Trousseau Hospital, Pierre et Marie Curie University, Paris, France.|INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemilogy Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carbajal
mesh_terms: D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000453:epidemiology*; D012189:Retrospective Studies; D012306:Risk; D003294:Seizures, Febrile / Q000453:epidemiology*; D013129:Spinal Puncture / Q000706:statistics & numerical data*