Association of SARS cov2 Infection on Patients Presenting with Febrile Seizures in the Pediatric Emergency Department
Abstract number :
3.095
Submission category :
2. Translational Research / 2A. Human Studies
Year :
2022
Submission ID :
2205008
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Jina Park, CNA – Children's National Medical Center; Dr. James Chamberlain, MD – CNMC; Dr. William Gaillard, MD – CNMC; Kara Hom, Researcher – CNMC
Rationale: Febrile seizures (FS) are the most common type of convulsions in young children and occur in 2-5% of American children before the age of five.1 Prolonged seizure over 30 minutes (complex FS) carries the risk of epilepsy. Common dispositions of a febrile seizure is a fever over 38.3°C with loss of consciousness.2 The SARS-CoV2 virus had multiple variants and it was found that children who develop fevers because of COVID transmission can manifest febrile seizures. Therefore, the objective was to evaluate the differences in FS expression pre-COVID and post-COVID (Delta+Omicron variants).
Methods: Data were chosen using 125 retrospective chart reviews of those with FS in the ED pre-COVID and during Delta/Omicron. The Delta and Omicron waves were chosen based on peak dates from the CDC. The chart review dates are: Omicron (12/19/21-1/15/21), Delta (8/25/21-9/25/21), and pre-COVID (11/1/18-1/14/19).
The inclusion criteria were infants (1 month) to young children (5 Y.O.) who presented with a fever ( >38.3°C) with a return to baseline. The exclusion criteria were those with neurologic disorders, severe developmental delays, and major structural abnormalities.
Results: Seizure lengths were categorized from less than five minutes, between 5-15 minutes, and >15 minutes. The Omicron cohort had the highest number of seizures below five minutes (36/70 cases), and also had the highest number of seizures between 5-15 minutes (18/40 cases). Meanwhile, the Delta cohort had the highest case of seizures >15 minutes (7/13 cases).
Out of 48 patients, 35 patients with FS history used no anti-seizure medications while 13 patients were given anti-seizure meds. This is compared to 68 patients with no FS history where 62/97 patients were not given anti-seizure meds.
The ANOVA test was used to determine significance. The p-value for the average seizure lengths among cohorts was significant (p=0.023), indicating that there could be a relationship between COVID infections and FS presentation. However, the relation between fever temperature and FS presentation is not significant (p=0.65). In the Delta wave, patients were seizing for longer periods of time compared to the Omicron or pre-COVID cohort. The lack of COVID cases seen during the Delta wave could be due to quarantine precedent, a hesitation to seek Emergency Rooms, and the no use of rescue medications.
Since the Omicron and Delta cohorts had different seizure times, this could indicate that an Omicron infection with FS could have a different inflammatory response.
Conclusions: Future directions involve expanding study dates to when COVID was first introduced (March 2020) and finding a higher number of patient charts to review. It is also important to study the effects of COVID on children with FS and see whether COVID can cause FS in pediatric patients.
References:
1. Marks KJ, Whitaker M, Agathis NT, et al. Hospitalization of Infants and Children Aged 0–4 Years with Laboratory-Confirmed COVID-19— COVID-NET,March 2020–February 2022.MMWR Morb Mortal Wkly Rep 2022;71:429–436.
2. U.S. Department of Health and Human Services.Febrile seizures sheet.National Institute of Neurological Disorders and Stroke.
Funding: None
Translational Research