A study of the efficacy of antipyretic drugs in the prevention of febrile seizure recurrence

I. Clinical Question: Does administration of antipyretic drugs prevent the

recurrence of febrile seizure?

II. Citation: Van Esch A, Steyerberg E, Moll A, et al. Department of Paediatrics, University Hospital Rotterdam/Sophia Children’s Hospital, Rotterdam, Netherlands.

III. Study Characteristics

1. Patients included:

Children between the age of 10 and 36 months.

2. Interventions compared:

Children who was given treatment with ibuprofen or acetaminophen syrup during fever (treatment group)

Children who was not given antipyretic treatment during fever (control group)

3. Outcomes compared:

According to the intention-to-treat analysis, the hazard ratio of any recurrence in the treatment group compared with the control group was 1.1. The recurrence risk per fever was 15% in the treatment group and 12% in the control group. In the exploratory on-treatment analysis, the recurrence risk in the treatment group was estimated 6.9% in the treatment group versus 12% in the control group.

4. Does the study focus on a significant problem in clinical practice?

This study focuses on significant problem on clinical practice. Febrile seizures (FS) are the most common type of seizures in childhood between 10 months-36 months. It is very useful to know the risk and advantages of antipyretic drugs in the prevention of febrile seizure reccurence.

IV. Methodology/Design

1. Methodology used

The methodology used in this research is by doing an intervention and observation of the expected adverse effects.

2. Design

An experimental and a descriptive patient series, both prospectively followed, were combined in this study.

3. Setting

This study was conducted on the outpatient department of the Sophia Children’s Hospital, Netherlands.

4. Data Sources

This trial was made by A Van Esch, at the outpatient department of the Sophia Children’s Hospital, Netherlands.

5. Subject Selection

Inclusion criteria were Children who visited the Sophia Children’s Hospital because of a FS experienced between the age of 10 and 36 months were recruited as part of an ongoing FS follow-up study.

Children with neurological diseases (e.g. epilepsy, psychomotor retardation) and children receiving continuous treatment with anticonvulsive drugs were excluded from this study.

6. Has the original study been replicated?

This study was already done before. Thus, this only means that even from the past until now, and in the future there are still studies for this kind of problem. Thru this new study, it gives more information and also it inquires more related health knowledge.

7. What are the risks and benefits of the nursing action/intervention tested in the study?

The preventive effect of intermittent antipyretic prophylaxis on the recurrence of febrile seizures is probably small. Prescription of antipyretic drugs in FS children should be limited to situations where comfort or safety is the main concern. A more powerful antipyretic drug, or a higher dose of acetaminophen administered to children with a high recurrence risk might have a preventive effect on FS recurrences.

In this study the benefits is in the part of knowing which of the two interventions compared has a better effect.

V. Results of the Study

The risk of any recurrence did not substantially differ between treatment group and control group: risks were 56 versus 58% at 3 years of age (Table 2). These high risks are explained by the fact that all recurrences per child were taken into account. The univariate hazard ratio for any recurrence was 1.0 (95% CI, 0.6–1.6), the adjusted hazard ratio was 1.1 (95% CI, 0.7–1.8), indicating that the treatment group had a slightly higher risk of FS recurrence risk adjusted for the children’s risk profile.

The risk of a recurrence per fever in the treatment group was 15%, and

in the control group 12%. The crude risk ratio for treatment was 1.2 (95% CI, 0.7–2.2); the adjusted risk ratio was 1.3 (95% CI, 0.7–2.3), again indicating a slightly higher risk of FS recurrence risk for the treatment group.

The distribution of the baseline characteristics of the treatment group (n = 66) and the control group (n = 102) in the on-treatment analysis were similar to the distribution shown in Table 1. Table 2 shows that five recurrences occurred in the treatment group, resulting in a 6.8% (five of 79) recurrence risk. In the control group, the recurrence risk was 12% (59 of 482). Thus, a 5.4% lower recurrence risk was observed in the treatment group. This means that around 20 fevers (1/0.054) would have to be treated to prevent

one recurrence. The crude risk ratio for treatment versus control was 0.5 (95% CI, 0.2–1.2) and the adjusted risk ratio was 0.5 (95 % CI, 0.2–1.3).

VI. Authors Conclusion/Recommendations

1. What contribution to client health status does the nursing action/intervention make?

Antipyretic treatment may have little or no preventive effect on the recurrence of febrile seizures in common practice. Some reduction of the risk of a recurrence may be acquired under optimal circumstances, namely that fever is noticed at once and that antipyretic drugs can be administered on time.

VII. Applicability1. Does the study provide a direct enough answer to your clinical question in

terms of type of patients, intervention and outcomes? 

Yes. It gives direct answer to my clinical question because it sited methods to have a good result and also it provides enough data to answer the unanswered question.

2. Is it feasible to carry out the nursing action in the real world?

I think it is not that safe to carry out the nursing action in the real world because conducting the study can produce undesired outcomes like occurrence of fever in children. This may put the patient to risk even though there are still benefits.

VIII. Reviewer’s Conclusion/Commentary

They conclude that antipyretic treatment may have little or no preventive effect on the recurrence of febrile seizures in common practice. Some reduction of the risk of a recurrence may be acquired under optimal circumstances, namely that fever is noticed at once and that antipyretic drugs can be administered on time.

References

1. Offringa M, Hazebroek A A J M and Derksen-Lubsen G (1991) Prevalence of febrile seizures in Dutch schoolchildren. Paediatric and Perinatal Epidemiology, 5: 181–181.

2. Verity C M, Butler N R and Golding J (1985) Febrile convulsions in a national cohort followed up from birth. I: prevalence and recurrence in the first year of life. British Medical Journal, 290: 1307–1310.

3. Nelson K B and Ellenberg J H (1978) Prognosis in children with febrile seizures. Paediatrics, 61: 720–727.

4. Shirts S B, Hauser A, Annegers J F and Kurland L T (1987) Risk of recurrence of febrile seizures in a population-based cohort of children, Rochester, MN. Neurology, 37: 149 (Abstract).

5. Offringa M, Bossuyt P M M, Lubsen J et al. (1994) Risk factors for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five studies. Journal of Pediatrics, 124: 574–584.

6. Esch A, Steyerberg E W, Berger M Y, Offringa M, Derksen-Lubsen G and Habbema J D F (1994) Family history and febrile seizure recurrences. Archives of Disease in Childhood, 70: 395–399.

7. Berg A T, Shinnar S, Hauser W A and Leventhal J M (1990) Predictors of recurrent febrile seizures: a metaanalytic review. Journal of Pediatrics, 116: 329–337.

Reaction:

As the essential sign of a febrile seizure is a fever, physicians and pediatric nurses have concluded that antipyretic measures should prevent febrile seizures. Antipyretics continue to be among the most commonly prescribed medications, especially for children at risk of such seizures. Parents are usually advised that the administration of antipyretics to at risk children may reduce the risk of further convulsions.

There is no evidence that antipyretics reduce the risk of subsequent febrile convulsions in at risk children Prescription of paracetamol following febrile seizures may provide comfort and symptomatic relief, but should not be recommended to prevent further febrile convulsions