Evaluation of febrile neonates or infants is far more important than fever reduction (Smitherman et al., 2017; Ward, 2016), but it is also challenging. Because of their age and level of development, the physical exam is a somewhat limited tool. There are fewer behavioral clues that can determine the severity of the illness or determine the child's illness. This patient population is more difficult to evaluate than older children. Also, a fever in these age groups is more likely to indicate the presence of a serious bacterial infection (SBI), and an infection in the first week of life is likely to be from vertical transmission from the mother. Febrile neonates and infants are at risk for febrile seizures.
Febrile seizures are a complication of common febrile illnesses occurring in children, and febrile seizures are the most common cause of seizures in the pediatric population. The definition of a febrile seizure is seizures occurring in a child aged 6-60 months with a temperature ≥ 38 degrees C (100.4 degrees F) and no central nervous system infection, metabolic disturbance, or history of afebrile seizure (Ganzales, 2016).
Febrile seizures are the most common cause of seizures in children (Feng et al., 2016). The exact incidence of febrile seizures is unknown, but it has been estimated to be 2%-5% (Feng et al., 2016; Gonzales, 2016; Nilsson et al., 2016). Febrile seizures are most often associated with common infectious illnesses such as otitis media and upper respiratory infections. The most powerful risk factor for febrile seizures is age (Whelan et al., 2017). Other factors that may contribute to an increased risk for febrile seizures include (Gonzales, 2016; Sharawat et al., 2016).
- Antenatal complications
- Daycare attendance
- Developmental delay
- Family history of febrile seizure
- Male gender
- High peak body temperature
- Selenium and zinc deficiency
- Microcytic hypochromic anemia
Childhood vaccinations have been associated with an increased risk for febrile seizures, but the risk is small (Francis et al., 2016; Gonzales, 2016).
Most febrile seizures are what are called simple febrile seizures. The seizure is generalized; the seizure duration is < 15 minutes; there is only one seizure in 24 hours; there are no post-seizure complications or sequelae. The child has no history of neurological disease (Whelan et al., 2017). Serious neurological sequelae can occur, albeit rarely, after a simple febrile seizure, especially if the seizure was particularly long or severe. The child had an extremely high fever, or the seizure was caused by infection with measles or salmonella (Whelan et al., 2017).
Febrile seizures may occur once, or they may be recurrent. The risk of recurrent febrile seizures is approximately 30%-35% (Millchap et al., 2016). The risk of recurrence varies considerably. Risk factors are: (Millchap et al., 2016)
- Very young children
- First-degree relative who had febrile seizures
- A brief period between the onset of fever and the first febrile seizure
There are also complex febrile seizures and febrile status epilepticus (Whelan et al., 2017). Complex febrile seizures are seizures that focal or localized with a duration longer than 15 minutes but less than 30 minutes or involve recurrence of seizures in 24 hours; 20–25% of febrile seizures are complex (Whelan et al., 2017).
Approximately one-third of febrile seizures are complex febrile seizures and are associated with a risk of developing epilepsy (Feng et al., 2016). This risk has been estimated at 6%-7% but varies widely. Some research has not found an association between complex febrile seizures and epilepsy (Whelan et al., 2017).
Febrile status epilepticus is a prolonged seizure, lasting longer than 30 minutes (Whelan et al., 2017; Millchap et al., 2016). Children who have febrile status epilepticus appear to have the same basic risk factors for febrile seizures as children who have simple febrile seizures (Millchap et al., 2017).
Febrile seizures are treated on an individual basis. Simple febrile seizures do not require specific care, and they usually resolve spontaneously. Complex febrile seizures may be treated with antiepileptic medications (Millchap et al., 2016). Antipyretics can make the child more comfortable, but they will not prevent a recurrence (Millchap et al., 2016).