大多数的婴儿有无并发症的热性发作，可以避免脊髓龙头

最大的审查日期问题目前的建议

2009年1月6日

波士顿，大众。--当孩子们发展发烧足够高或突然足够引起癫痫发作，害怕父母经常冲到急救室，在那里他们的检查通常包括腰椎穿刺（脊柱）排除细菌性脑膜炎。 Now, in the largest study to date, researchers at Children's Hospital Boston find that this uncomfortable procedure is probably not necessary in well-appearing children who have had a simple febrile 癫痫发作。 Findings are published in the January issue of儿科。

Simple febrile 癫痫发作s--a generalized 癫痫发作 lasting no more than 15 minutes and not recurring within 24 hours--are common in infants and young children, affecting 2 to 5 percent of children 6 months to 5 years old。 "This means we might see at least one case per day in the emergency room," says Amir Kimia, MD, of Children's Division of急救药品and the study's first author。 "When it's a first event, it's pretty scary for parents - they usually call 911。"

电流American Academy of 儿科recommendations, issued in 1996, call on physicians to consider doing a 腰椎穿刺 in children 12 to 18 months old with a first simple febrile 癫痫发作 and to "strongly" consider 腰椎穿刺 for infants 6 to 12 months old。 But when Amir and colleagues reviewed the medical charts of 704 babies seen at Children's emergency department for a first simple febrile 癫痫发作 between October 1995 and October 2006, they found no cases of 细菌性脑膜炎 in either age group。

Of the 704 babies, 271 (38 percent) underwent 腰椎穿刺。 Of these, 10 babies (3。8 percent) were found to have an elevated white-blood-cell count in their cerebrospinal fluid, indicating a possible viral infection, but no pathogen was identified in cerebrospinal fluid cultures, and no patient was diagnosed as having 细菌性脑膜炎。

This is the first large-scale study to focus specifically on 6- to 18-month-olds, who are considered to be at highest risk for 细菌性脑膜炎。 The findings are consistent with those of previous small-scale studies in this young age group and studies that included children up to age 6。

Lumbar puncture requires local anesthesia and often sedation。 "It is a safe procedure with an extremely low rate of complications," says Kimia。 "But it's a needle and it's not fun。 We're trying not to do it unless it's absolutely necessary。"

Physicians had already started to question its need, as evidenced by declining rates of 腰椎穿刺 over the 11-year study period。 One major reason is that rates of 细菌性脑膜炎 have greatly declined because of the introduction of vaccines against H。 influenzae and pneumococcus, the two major pathogens that cause meningitis, in 1990 and 2000, respectively。 "Bacterial meningitis in vaccinated babies is a rare disorder, luckily, in our part of the world," says Kimia。

Simple febrile 癫痫发作s in babies tend to run in families and are believed to be a reflection of the immaturity of the brain in dealing with rapid changes in temperature。 Some researchers believe the speed of the change may be more important that the height of the temperature - even a rapid rise from 99 to 101 degrees Fahrenheit can trigger a 癫痫发作 in susceptible children, Kimia says。

However, the researchers caution that their findings don't necessarily extend to patients with complex febrile 癫痫发作s, patients with concerning symptoms or signs, or patients who have an underlying illness。

"Lumbar puncture should be considered based on clinical presentation, rather than being done routinely," says Kimia。 "If a child appears very ill, is lethargic, fussy, non-responsive, has neurologic symptoms, or has certain clinical signs (such as a certain type of rash or a bulging fontanelle), 腰椎穿刺 should be considered no matter how old the child is。"

Kimia hopes the findings will reassure anxious parents。 "We have a hard time convincing parents in the ER that their child doesn't need a workup," he says。 "Some, traumatized by the 癫痫发作, are convinced their child was about to die。 But if their child is running around in our ER and is smiling and happy, 腰椎穿刺 is probably not indicated。"

查看该文件，访问：http://pediatrics。aappublications。org/cgi/content/abstract/123/1/6

接触：
克里斯特德曼
617-919-3110
keri。stedman@childrens。harvard。edu

Children's Hospital Boston is home to the world's largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869。 More than 500 scientists, including eight members of the National Academy of Sciences, 11 members of the Institute of Medicine and 13 members of the Howard Hughes Medical Institute comprise Children's research community。 Founded as a 20-bed hospital for children, Children's Hospital Boston today is a 397-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families。 Children's also is the primary pediatric teaching affiliate of Harvard Medical School。 For more information about the hospital and its research visit:www。childrenshospital。org/newsroom

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