Patidar Ramesh, Shende Madhuri, Rajaram Saroj, Kadam Prashant R, P Shreeya, Rajput Reena
Pediatrics and Child Health, Zulekha Hospital, Sharjah, ARE.
Pediatrics and Child Health, Khurshitji Beharamji (KB) Bhabha Hospital, Mumbai, IND.
Cureus. 2025 Aug 12;17(8):e89861. doi: 10.7759/cureus.89861. eCollection 2025 Aug.
Febrile seizures (FS) are common in children aged 6-60 months and often cause concern because of their potential association with central nervous system (CNS) infections like occult meningitis. While most FS are benign, distinguishing simple from complex cases is significant. This systematic review aims to evaluate the diagnostic utility and necessity of cerebrospinal fluid (CSF) analysis in young children presenting with FS to guide appropriate clinical decision-making. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines where literature was searched in PubMed, Cochrane Library, Web of Science, and Google Scholar (2015-2025) using terms related to FS, CSF analysis, and children aged 6-60 months. Inclusion criteria focused on observational studies that reported lumbar puncture. Two reviewers independently screened studies and extracted data on seizure type, age, and CSF results. Over 1,306 records were screened, and nine studies were included that involved 3,143 children aged 6-60 months. CSF analysis usage varied widely from over 6% to 100%. Bacterial meningitis was detected in 0.7-14% without clinical signs. High yield was among infants under 18 months. The risk of bias was low in most studies. CSF analysis in FS should be guided by age, vaccination status, and clinical signs. A selective approach avoids unnecessary lumbar punctures while ensuring serious CNS infections are not missed.
热性惊厥（FS）在6至60个月大的儿童中很常见，由于其可能与隐匿性脑膜炎等中枢神经系统（CNS）感染有关，常常引起关注。虽然大多数FS是良性的，但区分简单病例和复杂病例很重要。本系统评价旨在评估脑脊液（CSF）分析在出现FS的幼儿中的诊断效用和必要性，以指导适当的临床决策。本系统评价遵循系统评价和Meta分析的首选报告项目（PRISMA）指南，在PubMed、Cochrane图书馆、科学网和谷歌学术搜索（2015 - 2025年）中使用与FS、CSF分析以及6至60个月大儿童相关的术语进行文献检索。纳入标准侧重于报告腰椎穿刺的观察性研究。两名评审员独立筛选研究并提取有关惊厥类型、年龄和CSF结果的数据。共筛选了1306条记录，纳入了9项研究，涉及3143名6至60个月大的儿童。CSF分析的使用率差异很大，从6%以上到100%不等。在无临床体征的情况下，细菌性脑膜炎的检出率为0.7%至14%。18个月以下婴儿的检出率较高。大多数研究的偏倚风险较低。FS患者的CSF分析应以年龄、疫苗接种状况和临床体征为指导。选择性方法可避免不必要的腰椎穿刺，同时确保不漏诊严重的CNS感染。
