What is the emergency management for febrile seizures in an infant?

From the Guidelines

For a febrile infant presenting with a seizure, the emergency management should prioritize immediate stabilization and assessment for potential underlying infections, with a focus on sepsis evaluation and empiric antibiotic therapy as needed, based on the most recent guidelines from 2021 1. The management approach should consider the age of the infant and the severity of the presentation.

• For infants 8 to 60 days old, a full sepsis workup including blood, urine, and cerebrospinal fluid (CSF) cultures is recommended, along with empiric antibiotic therapy based on the suspected source of infection and the infant's age, as outlined in the 2021 guidelines 1.
• The choice of empiric antibiotics should be guided by the suspected source of infection and local antibiogram data when available, with options including ampicillin, ceftazidime, gentamicin, and ceftriaxone, depending on the age of the infant and the clinical scenario 1.
• Additional steps in management include obtaining a complete blood count (CBC) with differential and C-reactive protein (CRP), performing a chest X-ray if respiratory symptoms are present, monitoring vital signs closely, and ensuring proper hydration with IV fluids if needed. The approach is based on the understanding that febrile seizures in infants can be a presentation of underlying serious bacterial infections, and prompt identification and treatment are crucial to prevent morbidity and mortality, as emphasized in the guidelines from Pediatrics 1.
• The guidelines from 2008 1 provide a foundation for understanding febrile seizures but are superseded by the more recent recommendations from 2021 1 for the management of well-appearing febrile infants 8 to 60 days old.
• The management should always prioritize the infant's safety and the potential for serious underlying conditions, even if the seizure itself is considered simple or febrile in nature, highlighting the importance of a thorough evaluation and adherence to the most current clinical practice guidelines 1.

From the Research

Emergency Management for Febrile Seizures in Infants

The emergency management for febrile seizures in infants involves a thorough evaluation and standardized care approach. Key considerations include:

• Age of the infant: Management strategies vary based on the age of the infant, with febrile neonates (less than 1 month old) requiring thorough evaluation and aggressive treatment, while infants between 1-3 months old may be guided by clinical evaluation and laboratory investigations 2.
• Risk of serious bacterial infection (SBI): Infants with fever without a source are at risk for SBI, and algorithms based on analytical and clinical parameters can help differentiate between low- and high-risk infants 3.
• Laboratory testing: Complete blood count, blood culture, urine culture, and lumbar puncture may be performed, although the use of these tests can be reduced with the implementation of clinical practice guidelines (CPGs) 4, 5.
• Antibiotic administration: The selection of antibiotics should be carefully considered, taking into account clinical findings, laboratory data, and changing epidemiology 3.
• Hospitalization: Rates of hospitalization vary based on the age of the infant and the presence of risk factors for SBI, with higher rates of hospitalization among younger infants 5.

Evaluation and Disposition

The evaluation and disposition of febrile infants can be highly variable, particularly among infants who are 29-60 days old 5. CPGs can help standardize care and reduce unnecessary interventions, such as laboratory testing and hospitalization 4. The use of viral testing and chest radiography may also be reduced with the implementation of CPGs 5.

Management Strategies

Management strategies for febrile infants may include:

• Thorough physical examination and medical history 2
• Laboratory testing, such as complete blood count and blood culture 4, 5
• Antibiotic administration, with careful selection of antibiotics 3
• Hospitalization, based on the presence of risk factors for SBI and clinical evaluation 5
• Follow-up care, to monitor for signs of SBI or other complications 6