بررسی ضرورت پونکسیون مایع نخاع در کودکان مبتلا به اولین حمله تشنج و تب

Background: It is frequently thought that lumbar puncture (LP), is a mandatory procedure in all children presenting with febrile convulsion since convulsion may be the sole clinical manifestation of bacterial meningitis. The present study was conducted to assess whether meningitis could be recognized using readily available clinical information. Materials and methods: During the study period, 254 previously healthy children aged 6 months to 5 years were brought consecutively to the pediatric department of a teaching university hospital after their first febrile convulsion. Lumbar puncture (LP) was performed in all cases. Children with febrile convulsion and meningitis served as cases and those with febrile convulsion in the absence of meningitis, served as controls. The following factors were compared between groups: age, lethargy, irritability, vomiting, nuchal rigidity, bulging fontanel, headache, drowsiness, toxicity, coma, complex seizure, and prior antibiotic use. Results: Of 245 infants, 12(4.7%) had meningitis. The following risk factors were significantly associated with meningitis: lethargy (p<0.0006), irritability (p<0.0008), vomiting (p<0.0001), nuchal rigidity (p<0.0001), bulging fontanel (p<0.05), headache (p<0.006), drowsiness (p<0.0001), toxicity (p<0.0012), coma (p<0.005), complex seizure (p<0.04), and prior antibiotic use (p<0.0002). All children with meningitis had at least one of the following risk factors: prior antibiotic use, positive clinical manifestations. Conclusion: Our results indicate that clinical manifestations and type of convulsion (simple or complex) could be used to diagnose meningitis, thus, there is no need for routine "LP" in all children who present with fever and seizure. However a lumbar puncture is mandatory in infants younger than 12 months or those who have received prior antibiotics.