Outcome of lumbar puncture in children with first episode of complex febrile seizure admitted at tertiary care hospital in Nepal: a retrospective descriptive cross-sectional study

Abstract

Introduction: Complex febrile seizures (CFS) occur in 15–20% of children experiencing febrile seizures and often prompt lumbar puncture (LP) to rule out meningitis. However, widespread immunization with Haemophilus influenzae type b (Hib) and pneumococcal conjugate vaccines (PCV) has significantly reduced the incidence of bacterial meningitis. This study aimed to assess the diagnostic yield of LP in children presenting with a first episode of CFS at a tertiary care center in Nepal.

Method: This descriptive cross-sectional study was conducted at Patan Hospital from January 2021 to December 2023. Medical records of children aged 6 months to 5 years admitted with a first episode of CFS were retrospectively reviewed. CFS was defined as a febrile seizure lasting >15 minutes, focal, or recurring within 24 hours. Meningitis was defined by Cerebrospinal fluid (CSF) pleocytosis (>5 WBC/mm³) or positive culture. The data were analyzed via Microsoft Excel and the Statistical Package for Social Sciences (SPSS) version 16. We used descriptive statistics to determine the frequency of meningitis among children with CFS.

Result: Out of 76 children included, 50(65.79%) were male and the mean age was 2.04±0.94 years. LP was performed in 13(17.11%) children; 2(2.63%) had CSF pleocytosis. No pathogens were isolated on culture. All children had received Hib vaccination and 74(97.37%) received PCV. All recovered fully.

Conclusion: The proportion of meningitis was low among children with CFS who underwent LP, supporting selective LP use in fully immunized, well-appearing children. Clinical judgment and vaccination history remain key to avoiding unnecessary invasive procedures.