Research Article

A retrospective study of hemoglobin levels in

children with febrile seizures between the age group
6 months to 6 years
Vitus D’silva1*, K Shreedhara Avabratha2
1Junior Resident, 2Professor, Department of Pediatrics, Father Muller Medical College and Hospital, Kankanady, Mangalore-575002,
Karnataka, INDIA.
Email: [email protected], [email protected]

Abstract Introduction: Febrile seizureis the leading cause of convulsive disorder in paediatric age group with incidence varying
from 2-14 %.Iron deficiency anaemia is one of the risk factors known to be associated with febrile seizures. The
incidence of iron deficiency anemia among children 6 to 59 months in India is79% and the age for peak incidence of
febrile seizure is 14 to18 months, which overlaps with that of iron deficiency anemia which is 6 to 24 months. Iron
deficiency is the commonest micronutrient deficiency causing anemia and is a preventable and treatable condition.
Objectives: To find the prevalence of low hemoglobin in children presenting with febrile seizures and its correlation with
the type of febrile seizures. Results: Sixty four children diagnosed with febrile seizures over a period of 1 yearin a
tertiary care hospital were included, out of which 39 were males and 25 females. The prevalence of Simple febrile
seizures was 43 (67.2%) and Complex febrile seizures 21 (32.8%).Complex febrile seizure was significantly higher in
males compared to females. The prevalence of anemia was 42 % and among the total 27 children with anemia 19 (70.4%)
had simple febrile seizures and 8 (29.6%) had complex febrile seizures. However these findings were not statistically
significant, probably because the study involved small sample size and was conducted in a tertiary care hospital.
Conclusion: This study concludes that there is no statistically significant relation between low hemoglobin, febrile
seizures and type of febrile seizures. Further studies are needed to correlate anemia, febrile seizures and type of febrile
seizures and establish possible role of anemia as a risk factor.
Keywords: Febrile seizures, Anemia.
*
Address for Correspondence:
Dr. Vitus D’silva, Junior Resident, 2Professor, Department of Pediatrics, Father Muller Medical College and Hospital, Kankanady,
Mangalore-575002, Karnataka, INDIA.
Email: [email protected]
Received Date: 02/01/2020 Accepted Date: 12/03/2020
reported in Japan. The peak incidence is in the second
Access this article online year of life, with the average age of onset between 14
Quick Response Code: months and 18 months.2 The International League
Website: Against Epilepsy defines an Febrile Seizure as 'a seizure
www.statperson.com occurring in childhood between 1 month and 6 years of
age, associated with a fever more than 38C (rectal
temperature) not caused by an infection of the central
Volume 10 nervous system, without previous neonatal seizures or a
Issue 2 previous unprovoked seizure and not meeting criteria for
other acute symptomatic seizures.3 Simple febrile seizures
are generalized tonic clonic seizures, lasting less than 15
minutes and not recurring more than once within 24
INTRODUCTION
hours. Complex febrile seizures are focal, prolonged more
Febrile seizures are the most common convulsive disorder
than 15 minutes, recurrent more than once within 24
occurring in about 3 to 4% of children and frequent cause
hours.4 The recurrence rate of febrile seizure is between
of emergency hospital admission. Incidence varies from
30-40% with the rate climbing as the number of risk
2-14 % in different society. In United States and Europe
factors increased. The risk factors are family history of
incidence is 2-4 %,1 rates as high as 10 % has been

How to cite this article: Vitus D’silva, K Shreedhara Avabratha. A retrospective study of hemoglobin levels in children with febrile
seizures between the age group 6 months to 6 years. International Journal of Recent Trends in Science and Technology April to June
2020; 10(2): 20-23 http://www.statperson.com
International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 10, Issue 2, 2020 pp 20-23

febrile seizures, epilepsy, perinatal factors and low subjects included co-morbid conditions like children with
plasma ferritin level reflecting poor iron status or iron known cause of anaemia other than iron deficiency
deficiency. There have been reports of linkages to febrile anaemia, children on iron therapy, developmental delay.
seizures on several chromosomes, including 2q, 5q, 5, 8q, The study design was approved by the Institutional Ethics
19p, and 19q, with the strongest linkage on chromosome Committee of Father Muller hospital. Children were
2q. Anemia is defined as a reduction of the red blood cell grouped as simple and complex febrile seizures based on
(RBC) volume or hemoglobin concentration below the the clinical criteria. Routine haematological investigation
range of values occurring in healthy persons (less than 2 was performed in all children including haemoglobin
SD).5 The definition of anemia varies by sex and age. The levels, total counts and electrolytes which formed initial
most commonly used definitions of anemia come from seizure work-up. The hemoglobin estimation was done
the Centers for Disease Control and Prevention (CDC) using auto analyzer. The hemoglobin values obtained
and the World Health Organization (WHO).6 were correlated with febrile seizures and the type of
Infants 0.5 to 4.9 years < 11 gm/dl febrile seizure - simple and complex febrile seizure.
Children 5 to 11.9 years <11.5 gm/dl Collected data was analyzed by frequency, percentage,
It is estimated that 30% of the global population suffers mean and standard deviation. Further statistical analysis
from iron-deficiency anaemia; most of those affected live was done using chi-square test and t test using SPSS-18.P
in developing countries. The incidence of iron deficiency value < 0.05 was considered significant.
anaemia among children 6 months to 59 months in India
is 79%. This includes 26% who are mild anaemic, 40% RESULTS
who are moderately anaemic and 3% suffer from severe A total of 64 children diagnosed with febrile seizures at
anaemia (NFHS 3 conducted in 2006). Age for peak our hospital over a period of 1 year were included, out of
incidence of febrile seizure is 14-18 months, which which 39 were males and 25 females. The youngest child
overlaps with that of iron deficiency anaemia which is 6- was of the age 6 months and the oldest was of 5 years 4
24 months. Iron deficiency is the commonest months. The prevalence of Simple febrile seizures was 43
micronutrient deficiency worldwide, and is a preventable (67.2%) and Complex febrile seizures 21 (32.8%) (Table
and treatable condition. Among the numerous biological 1) .Complex febrile seizure was significantly higher in
effects of iron, there is considerable evidence that iron is males compared to females. The prevalence of anemia
also important for neurological functioning. Such was 42 %. Among the total 27 children with anemia 19
functions include neurotransmitter metabolism, myelin (70.4%) had simple febrile seizures and 8 (29.6%) had
formation, and brain energy metabolism. Iron is used as complex febrile seizures (Table 2).However these
cofactor for metabolism of many neurotransmitters, findings were not statistically significant, probably
monoamine and aldehyde oxidase in the brain.7 In the because the study involved small sample size and was
rodent model, iron deficiency affects regional monoamine conducted in a tertiary care hospital.
metabolism, in part through iron-dependent enzymes such
as tryptophan hydroxylase (for serotonin) and tyrosine DISCUSSION
hydroxylase (for dopamine and norepinephrine). Recent Anaemia and febrile seizures are two common disorders
research shows that iron deficiency also results in in paediatric patients. The relationship between anaemia
elevations in extracellular dopamine and norepinephrine and febrile seizures has been examined in several studies
and reductions in D1 and D2 receptors and all with conflicting results. Commonest cause for anaemia in
monoamine transporters. Iron deficiency decreased the children is iron deficiency. Iron is an essential element in
expression of cytochrome c oxidase, a marker of neuronal the metabolism and functioning of enzymes required in
metabolic activity.The purpose of this study is to neurochemical reactions. These include
determine the relationship between anemia, febrile monoamineoxidase, cytochrome, peroxidase and
seizures and type of febrile seizures and the possibility of catalase.8,9 Clinically neurological symptoms like poor
anemia as a risk factor for febrile seizures. attention span, learning deficits, poor memory, delayed
motor development and behavioural changes caused by
MATERIAL AND METHODS iron deficiency are well known.8,10,11 Its association with
This was a retrospective study conducted in Father Muller febrile seizures was first observed and published in mid
Medical College Hospital, Mangalore during the period 90’s in an Italian study.9 In 2009, Hartfield and
January 2012- December 2012 and included children colleagues, from University of Alberta, Canada reported
diagnosed with febrile seizures. The diagnosis was made in a retrospective study that children with febrile seizures
based on clinical examination and after ruling out other were twice as likely to have iron deficiency as those with
causes for acute seizures.Exclusion criteria for all febrile illness alone. Some international studies denied

Copyright © 2020, Statperson Publications, International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 10, Issue 2 2020
 Vitus D’silva, K Shreedhara Avabratha

any role of iron insufficiency in febrile seizures. In fact, anaemia. That may cause a decrease of the neurons over
in an Iranian study, Bidabadi and Moushaf from provocation and so decline the incidence of seizure.15
University of Guilan, concluded that iron deficiency is Hojjat Derakhshan far in his study concluded that the risk
less frequent in children with first febrile seizure.12 In of febrileseizure occurrence in anaemic children is less
2001, Naveed-ur-Rehman and colleagues conducted the common as compared to non-anaemic ones.16 Whereas,
only local study at Aga Khan University Hospital which Leela Kumari in her study concluded thatiron deficiency
convincingly associated iron deficiency anaemia as a risk is a significant risk factor for simple febrile seizures in
factor for febrile seizures.13 As in Kobrinski’s study, the children of age group 6 months to 3 years.17 In our study
incidence rate of iron deficiency anemia was significantly anaemia was found in 42.2 % of the total children.
higher in the febrile convulsion group compared with the However, there was no statistically significant association
controls. Kobrinski thought that iron deficiency anaemia between anaemia, febrile seizures and febrile seizure
may have a protective role against convulsion caused by type; probably because the study involved a small sample
fever.14 considering the mono-amino-oxidase as a size and was conducted in a tertiary care hospital where
stimulating neurotransmitter, it might be that its amount most of the children belonged to urban population.
and function reduction occurs during iron deficiency
Table 1: Prevalence of types of febrile seizures - simple and complex febrile seizures among different age groups and gender
Age group Simple febrile seizures Complex febrile seizures Total
< 1 year 5 7 12
1-2 years 23 8 31
P=0.156
2-5 years 14 5 19
Not significant
>5 years 1 1 2
Total 43 21 64
Gender
Male 22 17 39 P=0.022
Female 21 4 25 Significant
Total 43 21 64

Table 2: Prevalence of type of febrile seizures in anemic and non-anemic children

Anemia status Hemoglobin levels (gram %) Simple febrile seizures Complex febrile seizures Total
<11 (< 5yrs) 19 7 26
Anemia
<11.5 (>5yrs) 0 1 1
>11 (<5yrs) 23 13 36
No anemia
>11.5 (>5yrs) 1 0 1
Total 43 21 64
Mean hemoglobin ± SD (Standard P=0.789
11.16 ± 1.34 11.23 ± 0.87
Deviation) Not significant

Study Results
Hartfield Children with febrile seizures twice likely to have iron deficiency.
Naveed-ur-Rehman Iron deficiency is a risk factor for febrile seizures.
LeelaKumari Iron deficiency is a risk factor for febrile seizures.
Kobrinski Iron deficiency is more common in febrile seizures.
Bidabadi and Moushaf Iron deficiency less likely in febrile seizures.
HojjatDerakhshanfar Risk of febrile seizures in anaemic children is less compared to non-anaemics.

The study does have somelimitations. As it was a CONCLUSIONS

hospital-based study the prevalence of exposure and Our study concludes that there is no statistically
outcome variables may be different from acommunity significant correlation between anemia, febrile seizures
setting. Cause of anaemia was not the scope of the study. and type of febrile seizures. Further studies are needed to
We presumed iron deficiency to be the most common establish the correlation between occurrence of anemia
cause of anaemia. We recommend follow up studies on and type of febrile seizures and therefore to evaluate the
the same subjects to establish iron deficiency anaemia. possible role of anemia as a risk factor for febrile
seizures.

International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 10, Issue 2, 2020 Page 22
International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 10, Issue 2, 2020 pp 20-23

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Conflict of Interest: None Declared

Copyright © 2020, Statperson Publications, International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 10, Issue 2 2020