• Users Online: 16
  • Print this page
  • Email this page


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 1  |  Page : 20-23

A study on association of indicators of iron deficiency with febrile seizure in children admitted in pediatric emergency ward


Department of Pediatrics, BMC, Burdwan, West Bengal, India

Date of Submission11-Nov-2019
Date of Decision27-Dec-2019
Date of Acceptance12-Jan-2020
Date of Web Publication06-Nov-2020

Correspondence Address:
Dr. Kamirul Islam
Deptartment of Pediatrics, Burdwam Medical College, Burdwan, West Bengal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpai.jpai_15_20

Rights and Permissions
  Abstract 


Objectives: Febrile Seizure is the most common form of seizure in childhood. There are conflicting evidence regarding the association between iron deficiency and febrile seizure. Hence, this study was undertaken to find out the association between different indicators of iron deficiency with febrile seizure in children admitted in the Pediatric Emergency Ward of Burdwan Medical College, Burdwan. Methodology: A total of 159 children were selected by the complete enumeration method. Parameters of iron deficiency were estimated in them and age, sex-matched controls. Mann–Whitney U test and Spearman's rank-order correlation coefficient were used to find out the association between indicators of iron deficiency with febrile seizure. The binary logistic regression method was used to find out the adjusted odds ratio. P < 0.01 was considered statistically significant. Results: About 53.5% of the study population (mean age: 3.01 ± 1.37 years) was male. Mean hemoglobin, serum iron, serum ferritin, mean corpuscular volume, and mean corpuscular hemoglobin concentration were significantly higher in the control group, while the reverse is true for serum total iron-binding capacity. Serum ferritin became the most significant parameter, responsible for 57.3%–76.4% variability of febrile seizure. Overall, our model correctly predicted 50% variance of the dependent/outcome variable. Conclusion: Iron deficiency is more common among children with febrile seizure. Hence, iron prophylaxis may be given to children with febrile seizure. Further research (preferable multi-centric) should be conducted.

Keywords: Febrile seizures, ferritin, iron deficiency


How to cite this article:
Islam K, Datta AK, Roy A, Das R, Saha S, Seth S. A study on association of indicators of iron deficiency with febrile seizure in children admitted in pediatric emergency ward. J Pediatr Assoc India 2020;9:20-3

How to cite this URL:
Islam K, Datta AK, Roy A, Das R, Saha S, Seth S. A study on association of indicators of iron deficiency with febrile seizure in children admitted in pediatric emergency ward. J Pediatr Assoc India [serial online] 2020 [cited 2020 Nov 27];9:20-3. Available from: http://www.indjpai.com/text.asp?2020/9/1/20/300098




  Introduction Top


The most common type of seizure occurring in childhood is febrile seizure, which occurs in 2%–5% of children with normal neurological function.[1] Approximately five lakhs cases of febrile seizures occur every year in the US.[2] Two percent–4% cases of febrile seizures may develop epilepsy in future.[1],[3] Hence, identification of the risk factors of febrile seizure is important. Iron deficiency is the most common form of micronutrient deficiency in the world, affecting almost one-third population of the world. Anemia is the most common manifestation of iron deficiency. However, it also affects other organ systems, including the central nervous system (CNS) where it causes the behavioral problem, cognitive dysfunction, psychomotor retardation, etc., Iron deficiency is associated with altered development of hippocampal neurons, delayed maturation of myelin, and alteration of levels of different neurotransmitters, including serotonin, dopamine, etc.[4],[5] Iron deficiency also inhibits degradation of some neurotransmitters.[6] Moreover, iron deficiency is also aggravated by fever.[7] There is conflicting evidence on the association between iron deficiency and febrile seizure. Some studies identified iron deficiency as a potential risk factor of febrile seizure,[8],[9] while some found it as protective.[10] Some authors found no association between febrile seizure and iron deficiency.[11]

Since results are conflicting, and studies are scarce in the Indian context, this study was undertaken to find out the association between different indicators of iron deficiency and febrile seizure among the children admitted with febrile seizure in the Pediatric emergency ward of Burdwan Medical College, Burdwan.


  Methodology Top


A hospital-based case–control study was conducted among the children admitted with febrile seizure in between May 2016 and October 2016 in the pediatric emergency ward of Burdwan Medical College, Burdwan. 159 cases were selected by complete enumeration method (three children were excluded from the study, one for not giving consent, one was discharged on risk bond, and blood sample of one child was lost during transport to the laboratory). Age- and sex-matched controls were selected from febrile patients without any seizure. Some parameters such as hemoglobin, serum iron, serum ferritin, total iron-binding capacity (TIBC), mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC) were checked for both cases and controls. Blood samples were collected within 24 h of admission. For quality control, all the tests were done in the same laboratory of our college. Each report was double-checked by two different laboratory technicians. They were not informed about the purpose of the study. The same thermometer was used to check the axillary temperature of the participants.

Collected data were entered into Microsoft Excel Worksheet. Categorical data were coded (Febrile seizure: Yes-1/no-0). Mean and standard deviation was calculated for each variable. Using Shapiro–Wilk test (as sample size is <2000) we found that data were skewed. Hence, a nonparametric test (Mann–Whitney U-test) was used for checking the association between different variables in contingency tables. Significantly associated variables in the table were further considered for Spearman's rank-order correlation to find out the strength and association of the relationship, which is measured by Spearman's coefficient (ρ). Finally, a binary logistic regression model (forward conditional method) was created taking febrile seizure as dependent/outcome variable. Serum ferritin, iron, MCV, MCHC, TIBC, and hemoglobin were entered in step 1–6, respectively. The adjusted odds ratio was determined with 95% confidence interval. P < 0.01 was considered statistically significant. All the statistical analysis was done to by SPSS software version 19.0 (Statistical Package for the Social Sciences Inc., Chicago, IL, USA).

The febrile seizure was defined as a seizure occurring in childhood after 1 month of age, associated with a febrile illness not caused by an infection of the CNS, without previous neonatal seizures or a previous unprovoked seizure, and not meeting criteria for other acute symptomatic seizure.[12]


  Results Top


The mean age of the study population was 3.01 ± 1.37 years. 53.5% of them were male. Maximum of them were from the rural population (53.0%) and belonged to middle socioeconomic status (41.2%) according to the modified BG Prasad scale.

Mean hemoglobin level (9.40 ± 1.25 mg/dl vs. 13.12 ± 2.05 mg/dl), mean serum ferritin (53.15 ± 10.87 ng/ml vs. 81.88 ± 10.56 ng/ml), mean serum iron (67.46 ± 20.97 μg/dl vs. 141.37 ± 35.89 μg/dl), mean MCV (80.57 ± 6.14 fl vs. 90.79 ± 3.25 fl), and mean MCHC (29.42 ± 2.36 g/dl vs. 32.44 ± 1.89 g/dl) level were significantly higher in control group. On the other hand, mean TIBC level was significantly higher among cases (366.20 ± 80.25 μg/dl) than controls (296.85 ± 37.92 μg/dl) [Table 1]. Hence, there was a relative iron deficiency state among the cases.
Table 1: Value of different iron status indicators among cases and controls (n=318)

Click here to view


Febrile seizure is significantly and negatively correlated with hemoglobin (ρ = −0.744), serum ferritin (ρ = −0.785), serum iron (ρ = −0.782), MCV (ρ = −0.717) and MCHC (ρ = −0.581) signifying that an iron deficiency state may predispose to febrile seizure. While febrile seizure was significantly and positively correlated to serum TIBC (ρ = 0.424) [Table 2].
Table 2: The seven variable correlation matrix showing relationship between the dependent and independent variables with help of Spearman's Coefficient (n=318)

Click here to view


In our model, we found that higher level of serum ferritin, serum iron, MCV, and MCHC were protective for febrile seizure having an adjusted odds ratio of 0.757 (95% confidence interval: 0.640–0.895), 0.920 (95% confidence interval: 0.871–0.972), 0.527 (95% confidence interval: 0.331–0.839), and 0.386 (95% confidence interval: 0.156–0.951), respectively. Serum ferritin, serum iron, MCV, and MCHC can explain 73.6%–98.1% variance of febrile seizure. Serum ferritin alone can explain 57.3%–76.4% variance of febrile seizure. Overall, our model can correctly predict 50% of the outcome variable [Table 3]. Although serum iron and serum TIBC had a significant correlation with the dependent variable in the correlation matrix, they became insignificant in our regression model.
Table 3: Binary logistic regression model taking febrile seizure as dependent variable and different iron status indicators as independent variable (n=318)

Click here to view



  Discussion Top


Similar to the findings of our study, Modaresi et al. also found that mean hemoglobin, ferritin, iron, and MCH were lower in children with febrile seizures than the control group.[13] Akbayram et al. also found that serum iron level is lower in children with febrile seizure than healthy children.[14] Rehman and Billoo[9] also reported hemoglobin and serum ferritin level were significantly lower among children with febrile seizure than children without seizure. Similar to our finding Vaswani et al.[15] also noted that the mean serum ferritin level is significantly lower in cases of febrile seizure than controls. Choudhury[16]et al. also found that hemoglobin, MCH, and serum ferritin level were significantly lower in febrile seizure cases than controls. Fallah[17]et al. also noticed that serum hemoglobin, serum iron, and serum ferritin level were lower among children with febrile seizures that controls.

Contrary to our finding, Derakhshanfar[18]et al. reported that hemoglobin, serum iron, serum ferritin, and MCV level were higher and TIBC was lower among children with febrile seizure than febrile children without seizure. Similar to the findings of Derakhshanfar and et al., Kobrinsky[19]et al. also noted that hemoglobin, hematocrit, and MCV were higher in children with febrile seizure.

In different studies, Kumari[20]et al. (in India) Sherjil[21]et al. (in Pakistan) Sadeghzadeh[22]et al. (in Zanjan) found that the frequency of iron deficiency anemia was higher among the children with febrile seizure than their healthy counterparts/control group. On the other hand, Kobrinsky[19]et al. Talebian and Momtazmanesh,[23] and. Abaskhanian[24]et al. reported a higher prevalence of iron deficiency anemia among the control group than the children with febrile seizure. Amirsalari[11]et al. and Momen and Hakimzadeh[25] found no association between iron deficiency and febrile seizure.

These discrepancies may be due to differences in selection criteria, criteria of selection of controls, nutritional status of the participants, and different geographic areas of the studies (for example, if the study area is a malaria-endemic area, iron deficiency may be more prevalent in the control group too).


  Conclusion Top


Indicators of iron deficiency should be checked in all children with febrile seizure, and iron prophylaxis should be given to those who have iron deficiency. Further studies have (preferably multi-centric) to be undertaken to find out the other risk factors of febrile seizure as our model can predict only 50% of the dependent variable.

Ethical approval

The study was approved by institutional ethics committee.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mikati MA. Seizures in Childhood. In: Kliegman RM, Stanton BF, Schor NF, St. Geme JW, Behrman RE, editors. Nelson Textbook of Pediatrics. 19th ed.. Philadelphia: Saunders; 2011. p. 2013-7.  Back to cited text no. 1
    
2.
Applegate MS, Lo W. Febrile seizures: Current concepts concerning prognosis and clinical management. J Fam Pract 1989;29:422-8.  Back to cited text no. 2
    
3.
Jones T, Jacobsen SJ. Childhood febrile seizures: Overview and implications. Int J Med Sci 2007;4:110-4.  Back to cited text no. 3
    
4.
Yadav D, Chandra J. Iron deficiency: Beyond anemia. Indian J Pediatr 2011;78:65-72.  Back to cited text no. 4
    
5.
Johnston MV. Iron deficiency, febrile seizures and brain development. Indian Pediatr 2012;49:13-4.  Back to cited text no. 5
    
6.
Lozoff B, Beard J, Connor J, Barbara F, Georgieff M, Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev 2006;64:S34-43.  Back to cited text no. 6
    
7.
Idro R, Gwer S, Williams TN, Otieno T, Uyoga S, Fegan G, et al. Iron deficiency and acute seizures: Results from children living in rural Kenya and a meta-analysis. PLoS One 2010;5:e14001.  Back to cited text no. 7
    
8.
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;313:343.  Back to cited text no. 8
    
9.
Rehman N, Billoo AG. Association between iron deficiency anemia and febrile seizures. J Coll Physicians Surg Pak 2005;15:338-40.  Back to cited text no. 9
    
10.
Talebian A, Momtazmanesh N. Febrile seizures and anemia. Iran J Child Neurol 2007:2:31-3.  Back to cited text no. 10
    
11.
Amirsalari S, Keihanidost Z, Ahmadi M, Sabouri A, Kavemanesh Z, Afshar P, et al. Relationship between iron deficiency anemia and febrile seizures. Iran J Child Neurol 2010;14:27-30.  Back to cited text no. 11
    
12.
Guidelines for epidemiologic studies on epilepsy. Commission on epidemiology and prognosis, international league against epilepsy. Epilepsia 1993;34:592-6.  Back to cited text no. 12
    
13.
Modaresi M, Mahmoudian T, Yaghini O, Kelishadi R, Golestani H, Tavasoli A, et al. Is iron insufficiency associated with febrile seizure? Experience in an Iranian hospital. J Compr Ped 2012;3:21-4.  Back to cited text no. 13
    
14.
Akbayram S, Cemek M, Büyükben A, Aymelek F, Karaman S, Yilmaz F, et al. Major and minor bio-element status in children with febrile seizure. Bratisl Lek Listy 2012;113:421-3.  Back to cited text no. 14
    
15.
Vaswani RK, Dharaskar PG, Kulkarni S, Ghosh K. Iron deficiency as a risk factor for first febrile seizure. Indian Pediatr 2010;47:437-9.  Back to cited text no. 15
    
16.
Choudhury MA, Zaman M, Mollah AH, Hoque MA, Fatmi LE, Islam MN, et al. Iron status in children with febrile seizure. Mymensingh Med J 2013;22:275-80.  Back to cited text no. 16
    
17.
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;3:200-3.  Back to cited text no. 17
    
18.
Derakhshanfar H, Abaskhanian A, Alimohammadi H, ModanlooKordi M. Association between iron deficiency anemia and febrile seizure in children. Med Glas (Zenica) 2012;9:239-42.  Back to cited text no. 18
    
19.
Kobrinsky NL, Yager JY, Cheang MS, Yatscoff RW, Tenenbein M. Does iron deficiency raise the seizure threshold? J Child Neurol 1995;10:105-9.  Back to cited text no. 19
    
20.
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;49:17-9.  Back to cited text no. 20
    
21.
Sherjil A, us Saeed Z, Shehzad S, Amjad R. Iron deficiency anaemia—a risk factor for febrile seizures in children. J Ayub Med Coll Abbottabad 2010;22:71-3.  Back to cited text no. 21
    
22.
Sadeghzadeh M, Khoshnevis Asl P, Mahboubi E. Iron status and febrile seizure- a case control study in children less than 3 years. Iran J Child Neurol 2012;6:27-31.  Back to cited text no. 22
    
23.
Talebian A, Momtazmanesh N, Moosavi SGH, Khojasteh MR. The relationship between anemia and febrile seizure in children under 5 years old. Iran J Pediatr 2006;16:79-82.  Back to cited text no. 23
    
24.
Abaskhanian A, Vahid Shahi K, Parvinnejad N. The association between iron deficiency and the first episode of febrile seizure. J Babol Univ Med Sci 2009;11:32-6.  Back to cited text no. 24
    
25.
Momen A, Hakimzadeh M. Case-control study of the relationship between anemia and febrile convulsion in children between 9 months to 5 years of age. Ahwaz Univ Med Sci 2003;35:50-4.  Back to cited text no. 25
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Methodology
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed26    
    Printed0    
    Emailed0    
    PDF Downloaded1    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]