Diagnosis and treatment of febrile seizures in infants

The article is professionally consulted by Master, Doctor Nguyen Thi An - Pediatrician - Neonatologist - Department of Pediatrics - Neonatology - Vinmec Ha Long International General Hospital.

Febrile convulsions in infants, more common in boys than girls. This phenomenon usually occurs in winter and spring. So, how to diagnose and treat infants with convulsions, when the baby has a febrile convulsion, what to do?

Febrile convulsion in infants is a condition in which convulsions occur when the child has a fever of 38 degrees Celsius or higher. Newborns have a higher risk of having a high fever that causes more seizures. Boys have a higher rate of febrile convulsions than girls, and this condition usually occurs in the winter-spring season.
The cause of febrile convulsion in infants is an acute illness that causes fever such as respiratory tract infection, gastrointestinal infection, or urinary tract infection,... However, it should be taken care of. I mean, it's not a neurological infection or a metabolic disorder.

Isolated Febrile Convulsions: Febrile neonatal seizures are not associated with a neurological abnormality, presenting as generalized convulsions lasting less than 15 minutes. Complex febrile seizures: Febrile convulsions are characterized by partial onset seizures lasting more than 15 minutes. Within 1 hour of the seizure, the nervous system is fully functional. However, it is possible that the seizures will recur.

Febrile seizures in neonates are diagnosed clinically by a thorough physical examination, with particular attention to the child's history and medical history. During the examination, it is necessary to evaluate the child's seizure characteristics, the state of febrile convulsions is those that occur and last for more than 30 minutes, the child does not recover consciousness between the seizures.
In addition, evaluation and search for evidence of acute CNS infection or metabolic disturbance should be sought.
Diagnosis of febrile seizures in neonates needs to be differentiated from other conditions such as encephalitis, bacterial meningitis, acute encephalopathy, epilepsy, dysentery syndrome, or the use of certain drugs.

Diagnostic tests for febrile seizures in infants include:
Hematology tests. Blood biochemical test. Urine test. X-ray. EEG: Indicated in case of complicated febrile convulsion or high fever causing seizures. Lumbar puncture : Indicated in children with suspected neurological infection.

Treatment of febrile seizures in neonates includes treatment during febrile episodes and prophylactic treatment outside of febrile episodes.

Treatment of febrile seizures in infants includes: Reducing fever - controlling body temperature, stopping convulsions (done in a medical facility), treating febrile convulsions and treating the causes of fever .

Temperature control, antipyretic treatment to quickly regain the child's body temperature when the child's fever is over 38 degrees Celsius. The antipyretic drugs used can be:
Ibuprofen: 5-10mg/kg/time, 6-8 hourly, not to exceed 40mg/kg/day. Acetaminophen: 10-15mg/kg/time, 4-6 hours/time, not to exceed 75mg/kg/day. Paracetamol : 15mg/kg/time, 4-6 hours/time (if fever persists), not to exceed 60mg/kg/day, orally or rectally. When using antipyretics for convulsions in neonates, it should be noted that the drug does not provide prophylaxis for convulsions and does not prevent recurrence of convulsions. Medicines help lower body temperature, but do not bring it down as soon as the temperature peaks.
Of the drugs used, ibuprofen is more recommended because of its longer-lasting effect than acetaminophen, especially it should be noted that ibuprofen and acetaminophen should not be used interchangeably. However, if acetaminophen is used in combination with barbiturates, it can help lower body temperature, but there is a risk of recurrent seizures.
In addition, reducing fever and convulsion in infants can be combined with applying warm water in the forehead, groin, armpits and expanding the child's clothes.

Treatment of seizures is indicated when the child has consecutive seizures and the seizures last for more than 5 minutes. The anticonvulsant that can be selected is:
Diazepam: 0.5mg/kg/time rectally or 0.3mg/kg/time slow IV, or Midazolam 0.1mg/kg/time IV slow. Lorazepam: 0.05 - 0.1mg/kg/time (not to exceed 4mg/time). After 5 minutes, if convulsions are not stopped, repeat rectal diazepam. Fosphenytoin: 15 - 20 mg/kg/time IV is used if, after repeated 2 doses of Diazepam, the seizure does not stop. Treatment of febrile convulsions in neonates, if after 5 minutes the convulsions are still not stopped, repeat Diazepam 0.1 - 0.3mg/kg/time intravenously (not to exceed 10mg/time). If the seizure persists, transfer to the resuscitation unit for intubation and treatment with Thiopentone or Propofol.

Treatment of febrile convulsions should be noted, in some cases, to prevent the child from biting the tongue, a soft object can be placed between the teeth or a tongue depressor is used.
Febrile convulsion in infants, if high fever causes seizures, it should be treated as epilepsy. Treatment of epilepsy during febrile episodes can be Depakine 20mg/kg/2 times/day or Gardenal 5mg/kg/day. In addition, determine the cause of fever in children to prescribe appropriate treatment.

In addition to febrile seizures in infants pay attention:
Control the child's temperature, especially when the body temperature rises. For children who often have recurrent seizures or are at risk of having seizures, consider the use of sedatives, antiepileptic drugs. Parents need to be consulted, guided on how to care and treat, and schedule regular check-ups for their children.

If febrile seizures in infants occur at home, parents can pay attention to the following home care instructions:
Put the baby to one side, make sure it is safe for the baby to lie down, loosen clothes for children, avoid irritation. Avoid putting anything hard or soft in your child's mouth. Note the time of the child's seizure as well as the seizure characteristics to inform the doctor. If febrile convulsion in an infant lasts up to 5 minutes, immediately take the child to the nearest medical facility for timely emergency or use anticonvulsant medicine as directed (diazepam rectal or midazolam spray). nose,...) When the child has a fever of 38 degrees Celsius or higher, give the child fever-reducing medicine, then take the child to the doctor. If there is a doctor's prescription for the use of anticonvulsant drugs, they can be used. The diagnosis of febrile seizures in neonates should be distinguished from encephalitis, meningitis, and acute metabolic syndromes that cause fever. Treatment of febrile convulsions includes reducing fever, stopping the convulsion, and treating the condition and cause of the fever. When there is a need to diagnose and treat febrile seizures in children, parents can take their children to the facilities of Vinmec International General Hospital for a detailed examination by the hospital's doctors and experts. and timely treatment.

Reference sources: Nhidong.org.vn, benhviendktinhquangninh.vn