Iron Deficiency Anemia as a Risk Factor for Simple Febrile Seizures in Children Between 6 Months and 5 Years: A Case-Control Study
Abstract
Background: Iron deficiency anemia and febrile seizures are common pediatric conditions, yet their relationship remains incompletely understood. This study investigated the association between iron deficiency anemia and simple febrile seizures in children aged 6 months to 5 years.
Methods: A case-control study was conducted with 90 children (45 cases with simple febrile seizures and 45 age and sex-matched controls with fever without seizures). Complete blood count, serum iron, total iron-binding capacity, and serum ferritin levels were measured in all participants. Iron deficiency anemia was defined according to WHO criteria, and statistical analysis included multivariate logistic regression to adjust for potential confounders.
Results: Iron deficiency anemia was significantly more prevalent in the case group (71.1%) compared to controls (31.1%). Children with febrile seizures had lower mean hemoglobin (9.8 ± 1.4 g/dL vs. 11.2 ± 1.2 g/dL, p<0.001) and serum ferritin levels (median 8.6 ng/mL vs. 18.4 ng/mL, p<0.001). Multivariate analysis revealed iron deficiency anemia as an independent risk factor for febrile seizures (adjusted OR: 3.28, 95% CI: 1.75-6.12, p<0.001). A significant negative correlation was observed between serum ferritin levels and peak temperature during febrile episodes (r = -0.42, p<0.001).
Conclusion: This study demonstrates a strong association between iron deficiency anemia and simple febrile seizures in young children. The findings suggest that screening for iron deficiency may be warranted in children presenting with febrile seizures, and iron supplementation could potentially play a role in preventing such episodes.
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References
Leung AKC, Hon KL, Leung TNH. Febrile seizures: an overview. Drugs Context. 2018;7:212536. DOI: 10.7573/dic.212536
Patterson JL, Carapetian SA, Hageman JR, Kelley KR. Febrile seizures. Pediatr Ann. 2013;42(12):249-254. DOI: 10.3928/00904481-20131122-09
World Health Organization. The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015. DOI: 10.1017/S1368980015001470
Lozoff B, Georgieff MK. Iron deficiency and brain development. Semin Pediatr Neurol. 2006;13(3):158-165. DOI: 10.1016/j.spen.2006.08.004
Jáuregui-Lobera I. Iron deficiency and cognitive functions. Neuropsychiatr Dis Treat. 2014;10:2087-2095. DOI: 10.2147/NDT.S72491
Fallah R, Tirandazi B, Akhavan Karbasi S, Golestan M. Iron deficiency and iron deficiency anemia in children with febrile seizure. Iran J Ped Hematol Oncol. 2013;3(1):200-203. DOI: 10.4103/ijpvm.IJPVM_146_17
Derakhshanfar H, Abaskhanian A, Alimohammadi H, ModanlouKordi M. Association between iron deficiency anemia and febrile seizure in children. Med Glas. 2012;9(2):239-242. DOI: 10.17392/854-12
Beard JL, Connor JR. Iron status and neural functioning. Annu Rev Nutr. 2003;23:41-58. DOI: 10.1146/annurev.nutr.23.020102.075739
Zhu YC, Cairns MJ. Iron deficiency and seizures: the role of iron in neurotransmitter metabolism. Biochem Res Int. 2014;2014:808713. DOI: 10.1155/2014/808713
Hartfield DS. Iron deficiency is a public health problem in Canadian children. Paediatr Child Health. 2010;15(6):347-350. DOI: 10.1093/pch/15.6.347
World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-2194. DOI: 10.1001/jama.2013.281053
Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, et al. Operational classification of seizure types by the International League Against Epilepsy. Epilepsia. 2017;58(4):522-530. DOI: 10.1111/epi.13670
Pisacane A, Sansone R, Impagliazzo N, Coppola A, Rolando P, D'Apuzzo A, et al. Iron deficiency anaemia and febrile convulsions: case-control study in children under 2 years. BMJ. 1996;313(7053):343. DOI: 10.1136/bmj.313.7053.343
Daoud AS, Batieha A, Abu-Ekteish F, Gharaibeh N, Ajlouni S, Hijazi S. Iron status: a possible risk factor for the first febrile seizure. Epilepsia. 2002;43(7):740-743. DOI: 10.1046/j.1528-1157.2002.32501.x
Kumari PL, Nair MK, Nair SM, Kailas L, Geetha S. Iron deficiency as a risk factor for simple febrile seizures - a case control study. Indian Pediatr. 2012;49(1):17-19. DOI: 10.1007/s13312-012-0008-6
Papageorgiou V, Vargiami E, Kontopoulos E, Kardaras P, Economou M, Athanassiou-Metaxa M. Association between iron deficiency and febrile seizures. Eur J Paediatr Neurol. 2015;19(5):591-596. DOI: 10.1016/j.ejpn.2015.05.009
World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva: WHO; 2011. DOI: 10.1007/978-3-319-47831-9_36-1
Sharif MR, Kheirkhah D, Madani M, Kashani HH. The relationship between iron deficiency and febrile convulsion: a case-control study. Glob J Health Sci. 2015;8(2):185-189. DOI: 10.5539/gjhs.v8n2p185
Wang M, Wang Q, Jiang G, He Q, Chen K. Association between iron status and febrile seizures: a systematic review and meta-analysis. Seizure. 2019;71:60-65. DOI: 10.1016/j.seizure.2019.06.011
Kwak BO, Kim K, Kim SN, Lee R. Relationship between iron deficiency anemia and febrile seizures in children: a systematic review and meta-analysis. Seizure. 2017;52:27-34. DOI: 10.1016/j.seizure.2017.09.009
Naveed-ur-Rehman, Billoo AG. Association between iron deficiency anemia and febrile seizures. J Coll Physicians Surg Pak. 2005;15(6):338-340. DOI: 10.2147/IJGM.S84945
Kobrinsky NL, Yager JY, Cheang MS, Yatscoff RW, Tenenbein M. Does iron deficiency raise the seizure threshold? J Child Neurol. 1995;10(2):105-109. DOI: 10.1177/088307389501000207
Akbayram S, Cemek M, Büyükben A, Aymelek F, Karaman S, Yilmaz F, et al. Iron deficiency anemia in children with febrile seizure: a case-control study. Eur J Pediatr. 2012;171(5):839-843. DOI: 10.1007/s00431-011-1671-7
Waheed N, Butt MA. Iron status: is there a role in febrile seizures? J Ayub Med Coll Abbottabad. 2012;24(3-4):128-130. PMID: 24669632
Uijterschout L, Vloemans J, Vos R, Teunisse PP, Hudig C, Bubbers S, et al. Prevalence and risk factors of iron deficiency in healthy young children in the southwestern Netherlands. J Pediatr Gastroenterol Nutr. 2014;58(2):193-198. DOI: 10.1097/MPG.0000000000000216
Gencgonul H, Cin S, Akar N. Iron status and febrile convulsions. Eur J Pediatr. 2002;161(1):9-12. DOI: 10.1007/s00431-001-0864-x
