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Çocuklarda demir eksikliğinin febril konvülziyon ile ilişkisi

Year 2019, Volume: 44 Issue: 3, 1033 - 1039, 30.09.2019

Abstract

Amaç: Bu çalışmada  febril konvülziyon ve demir eksikliği arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. 

Gereç ve Yöntem: Ocak 2016 ve mayıs 2018 arasında, çocuk acil servisine febril nöbet öyküsü ile başvurmuş yaşları 3-60 ay arasında 94 çocuk çalışmaya dahil edildi. Kontrol grubu ise, herhangi bir ateşli hastalık nedeniyle hospitalize edilmiş ancak nöbet öyküsü olmayan aynı yaş ve cinsiyette 70 hastadan oluşturuldu. Hastalığın ilk gününde alınmış venöz kan örneklerinden çalışılan hemoglobin, hematokrit, ferritin, demir ve total demir bağlama kapasitesi hasta dosyalarından kaydedildi. 

Bulgular: Febril konvülziyon nedeniyle takip edilen hastaların hemoglobin ve ferritin değerleri, kontrol grubu ile karşılaştırıldığında anlamlı derecede düşük bulunmuştur [11,38 (1,00), 11,19 (1,29), 11,94 (0,90) p=0,001]. Ayrıca kompleks febril konvülziyon nedeniyle takip edilen hastaların hemoglobin ve ferritin değerleri de basit febril konvülziyonlu hastaların değerlerinden anlamlı düşük bulunmuştur. Çalışma ve kontrol gruplarında, febril konvülziyon gelişimini kolaylaştıran  faktörler lojistik regresyon analizi ile incelendiğinde, çalışma ve kontrol grupları arasında ferritin düşüklüğünün konvülziyon gelişme riskini 2.49 kat ve demir eksikliği anemisinin riski 1.63 kat arttırdığı gösterilmiştir.

Sonuç: Bu çalışmanın verileri ışığında, düşük ferritin düzeylerinin, akut ateşli hastalıkların seyri sırasında, febril konvülziyon gelişimi açısından bir risk faktörü olabileceği ancak rutin demir suplementasyonu önerebilmek için daha geniş serilerde yapılacak prospektif çalışmalara ihtiyaç olduğunu düşünmekteyiz.


References

  • Kliegman, R. M. (2015). Nelson Textbook of Pediatrics (20th ed.). W. B. Saunders Co.
  • Jones, T., & Jacobsen, S. J. (2007). Childhood Febrile Seizures: Overview and Implications. Int J Med Sci, 4(2),110-4.
  • Ostergaard, J. R. (2009). Febrile Seizures. Acta Paediatr, 98(5), 771-3.
  • World Health Organization. Iron deficiency. assessment, prevention, and control: a guide for programme managers. Geneva: World Health Organization; 2001.
  • Gökçay G, Kılıç A. Çocuklarda demir eksikliği anemisinin epidemiyolojisi. Çocuk Sağlığı ve Hastalıkları Dergisi 2000; 43: 3-13.
  • Yager JY, Hartfield DS. Neurologic manifestations of iron deficiency in childhood. Pediatr Neurol 2002;27(2):85e92.
  • Erikson KM, Jones BC, Hess EJ, et al. Iron deficiency decreases dopamine D(1) and D(2) receptors in rat brain. Pharmacol Biochem Behav 2001; 69: 409-18.
  • Tanabe T, Suzuki S, Hara K. Cerebrospinal fluid and serum neuron- specific enolase after febrile seizures. Epilepsia 2001;42(4): 504-7.
  • 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.
  • American Academy of Pediatrics. Provisional Commitee on Quality Improve-ment. Practice parameter. Long term treatment of the child with simple febrile se-izures. Pediatrics 1999;103:1307-9.
  • Lo SF. Reference intervals for laboratory tests and procedures. In: Kliegman RM, Stanton BF St, Geme JW, et al, eds. Nelson Textbook of Pediatrics, 20th ed. Philadelphia, PA: Elsevier Sunders; 2015:3465–3473.
  • Phiri K, Calis J, Siyasiya A, et al. New cut-off values for ferritin and soluble transferrin receptor for the assessment of iron deficiency in children in a high infection pressure area. J Clin Path. 2009;62:1103–1106.
  • Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W, et al: Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia 2010;51(4):676–85.
  • Landreau-Mascaro A, Barret B, Mayaux MJ, Tardieu M, Blanche S. Risk of early febrile seizure with perinatal exposure to nucleoside analogues. Lancet2002;359(9306):583–4.
  • Özaydin E, Yaşar MZ, Güven A, Değerliyurt A, Vidinlisan S, Köse G. Febril konvülziyonlu 1385 vakanın klinik özellikleri ve risk faktörleri. Türkiye Çocuk Hast. Derg 2011;5(1):11-8.
  • Graves RC, Oehler K, Tingle LE. Febrile seizures: risks, evaluation, and prognosis. Am Fam Physician 2012;85(2):149–53.
  • Kobrinsky NL, Yager JY, Cheang MS, Yatscoff RW, Tenebein M. Does iron deficiency raise the seizure threshold? J Child Neurol 1995;10(2):105–9.
  • Momen AA, Hakim ZM. Case control study of relationship between anaemia and febrile convulsion in children between 9 months to 5 years of age. Jundishapur Sci Med J 2003;35(3):50–4.
  • WHO/UNICEF. Iron Deficiency Anaemia: Assessment, prevention, and control. Geneva: World Health Organization, 2001 (WHO/NHD/ 01.3). (http://www. who.int/nut/documents/ida_assessment_prevention_ control.pdf, accessed 03 March 2009).
  • Beard JL. Iron deficiency alters brain development and functioning. J Nutr 2003;133(5 Suppl 1):S1468–72.
  • Batra J, Seth PK. Effect of iron deficiency on developing rat brain. Indian J Clin Biochem 2002;17(2):108–14.
  • Swann I, Kendra J. Severe iron deficiency anaemia and stroke. Clin Lab Haematol 2000;22:221e3.
  • Lahat E, Heyman E, Livne A, Goldman M. Iron deficiency in children with attention deficit hyperactivity disorder. Isr Med Assoc J 2011;13:530e3.
  • Zehetner A, Orr N, Buckmaster A, Williams K, Wheeler D. Iron supplementation for breath-holding attacks in children. Cochrane Database Syst Rev 2010;12. CD008132.
  • Vaswani RK, Dharaskar PG, Kulkarni S, Ghosh K. Iron deficiency as a risk factor for first febrile seizure. Indian Pediatr 2010;47(5):437-9.
  • Ghasemi F, Valizadeh F, Taee N. Iron-deficiency anemia in children with febrile seizure: a case-control study. Iran J Child Neurol 2014;8(2):38e44.
  • Anderson GJ, Frazer DM. Current understanding of iron homeostasis. Am J Clin Nutr 2017;106(Suppl 6):1559–1566
  • Lanzkowsky P. Appendix 1. Hematologic reference values. In: Lanzkowsky P,editor. Manual of pediatric hematology and oncology. 4th edition. California, USA; Macmillan Company 2005. p. 775–99.
  • Clark SF. Iron deficiency anemia: diagnosis and management. Curr Opin Gastroenterol 2009;25:122–8.
  • Daoud AS, Batieha A, Abu-Ekteish F, et al. Iron status: a possible risk factor for the first febrile seizure. Epilepsia. 2002; 43:740–743
  • Amirsalari S, Keihani Doust ZT, Ahmadi M, et al. Relationship between iron deficiency anemia and febrile seizures. Iran J Child Neurol. 2010;4:27–30.
  • Heydarian F, Vatankhah H. The role of anemia in first simple febrile seizure in children aged 6 months to 5 years old. Neurosciences (Riyadh). 2012;17:226–229.
  • Papageorgiou V, Vargiami E, Kontopoulos E, et al. Association between iron deficiency and febrile seizures. Eur J Paediatr Neurol. 2015;19:591–596.
  • Derakhshanfar H, Abaskhanian A, Alimohammadi H, et al. Association between iron deficiency anemia and febrile seizure in children. Med Glas (Zenica). 2012;9:239–242.

The relationship between iron deficiency and febrile convulsion in children

Year 2019, Volume: 44 Issue: 3, 1033 - 1039, 30.09.2019

Abstract

Purpose: The aim of this study was to evaluate the relationship between febrile convulsion and iron deficiency.

Materials and Methods: Between January 2016 and May 2018, 94 children aged between 3 and 60 months who were admitted to the pediatric emergency department with a history of febrile seizures were included in the study. The control group consisted of 70 patients who were hospitalized for any febrile illness but had no history of seizures. Hemoglobin, hematocrit, ferritin, iron and total iron binding capacity studied from venous blood samples taken on the first day of the disease were recorded from the patient files. 

Results: Hemoglobin and ferritin levels were significantly lower in patients with febrile convulsion compared to the control group [11.38 (1.00), 11.19 (1.29), 11.94 (0.90) p=0.001]. In addition, hemoglobin and ferritin values of patients who were followed because of complex febrile convulsions were also found to be significantly lower than those of simple febrile convulsions. When the factors facilitating the development of febrile convulsions in the study and control groups were analyzed by logistic regression analysis, it was shown that the low ferritin level increased the risk of convulsion by 2.49 times and iron deficiency anemia increased the risk by 1.63 times.

Conclusion: In the light of the data from this study, we believe that low ferritin levels may be a risk factor for the development of febrile convulsions during the course of acute febrile diseases, but prospective studies to be performed in larger series to recommend routine iron supplementation are needed.


References

  • Kliegman, R. M. (2015). Nelson Textbook of Pediatrics (20th ed.). W. B. Saunders Co.
  • Jones, T., & Jacobsen, S. J. (2007). Childhood Febrile Seizures: Overview and Implications. Int J Med Sci, 4(2),110-4.
  • Ostergaard, J. R. (2009). Febrile Seizures. Acta Paediatr, 98(5), 771-3.
  • World Health Organization. Iron deficiency. assessment, prevention, and control: a guide for programme managers. Geneva: World Health Organization; 2001.
  • Gökçay G, Kılıç A. Çocuklarda demir eksikliği anemisinin epidemiyolojisi. Çocuk Sağlığı ve Hastalıkları Dergisi 2000; 43: 3-13.
  • Yager JY, Hartfield DS. Neurologic manifestations of iron deficiency in childhood. Pediatr Neurol 2002;27(2):85e92.
  • Erikson KM, Jones BC, Hess EJ, et al. Iron deficiency decreases dopamine D(1) and D(2) receptors in rat brain. Pharmacol Biochem Behav 2001; 69: 409-18.
  • Tanabe T, Suzuki S, Hara K. Cerebrospinal fluid and serum neuron- specific enolase after febrile seizures. Epilepsia 2001;42(4): 504-7.
  • 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.
  • American Academy of Pediatrics. Provisional Commitee on Quality Improve-ment. Practice parameter. Long term treatment of the child with simple febrile se-izures. Pediatrics 1999;103:1307-9.
  • Lo SF. Reference intervals for laboratory tests and procedures. In: Kliegman RM, Stanton BF St, Geme JW, et al, eds. Nelson Textbook of Pediatrics, 20th ed. Philadelphia, PA: Elsevier Sunders; 2015:3465–3473.
  • Phiri K, Calis J, Siyasiya A, et al. New cut-off values for ferritin and soluble transferrin receptor for the assessment of iron deficiency in children in a high infection pressure area. J Clin Path. 2009;62:1103–1106.
  • Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W, et al: Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia 2010;51(4):676–85.
  • Landreau-Mascaro A, Barret B, Mayaux MJ, Tardieu M, Blanche S. Risk of early febrile seizure with perinatal exposure to nucleoside analogues. Lancet2002;359(9306):583–4.
  • Özaydin E, Yaşar MZ, Güven A, Değerliyurt A, Vidinlisan S, Köse G. Febril konvülziyonlu 1385 vakanın klinik özellikleri ve risk faktörleri. Türkiye Çocuk Hast. Derg 2011;5(1):11-8.
  • Graves RC, Oehler K, Tingle LE. Febrile seizures: risks, evaluation, and prognosis. Am Fam Physician 2012;85(2):149–53.
  • Kobrinsky NL, Yager JY, Cheang MS, Yatscoff RW, Tenebein M. Does iron deficiency raise the seizure threshold? J Child Neurol 1995;10(2):105–9.
  • Momen AA, Hakim ZM. Case control study of relationship between anaemia and febrile convulsion in children between 9 months to 5 years of age. Jundishapur Sci Med J 2003;35(3):50–4.
  • WHO/UNICEF. Iron Deficiency Anaemia: Assessment, prevention, and control. Geneva: World Health Organization, 2001 (WHO/NHD/ 01.3). (http://www. who.int/nut/documents/ida_assessment_prevention_ control.pdf, accessed 03 March 2009).
  • Beard JL. Iron deficiency alters brain development and functioning. J Nutr 2003;133(5 Suppl 1):S1468–72.
  • Batra J, Seth PK. Effect of iron deficiency on developing rat brain. Indian J Clin Biochem 2002;17(2):108–14.
  • Swann I, Kendra J. Severe iron deficiency anaemia and stroke. Clin Lab Haematol 2000;22:221e3.
  • Lahat E, Heyman E, Livne A, Goldman M. Iron deficiency in children with attention deficit hyperactivity disorder. Isr Med Assoc J 2011;13:530e3.
  • Zehetner A, Orr N, Buckmaster A, Williams K, Wheeler D. Iron supplementation for breath-holding attacks in children. Cochrane Database Syst Rev 2010;12. CD008132.
  • Vaswani RK, Dharaskar PG, Kulkarni S, Ghosh K. Iron deficiency as a risk factor for first febrile seizure. Indian Pediatr 2010;47(5):437-9.
  • Ghasemi F, Valizadeh F, Taee N. Iron-deficiency anemia in children with febrile seizure: a case-control study. Iran J Child Neurol 2014;8(2):38e44.
  • Anderson GJ, Frazer DM. Current understanding of iron homeostasis. Am J Clin Nutr 2017;106(Suppl 6):1559–1566
  • Lanzkowsky P. Appendix 1. Hematologic reference values. In: Lanzkowsky P,editor. Manual of pediatric hematology and oncology. 4th edition. California, USA; Macmillan Company 2005. p. 775–99.
  • Clark SF. Iron deficiency anemia: diagnosis and management. Curr Opin Gastroenterol 2009;25:122–8.
  • Daoud AS, Batieha A, Abu-Ekteish F, et al. Iron status: a possible risk factor for the first febrile seizure. Epilepsia. 2002; 43:740–743
  • Amirsalari S, Keihani Doust ZT, Ahmadi M, et al. Relationship between iron deficiency anemia and febrile seizures. Iran J Child Neurol. 2010;4:27–30.
  • Heydarian F, Vatankhah H. The role of anemia in first simple febrile seizure in children aged 6 months to 5 years old. Neurosciences (Riyadh). 2012;17:226–229.
  • Papageorgiou V, Vargiami E, Kontopoulos E, et al. Association between iron deficiency and febrile seizures. Eur J Paediatr Neurol. 2015;19:591–596.
  • Derakhshanfar H, Abaskhanian A, Alimohammadi H, et al. Association between iron deficiency anemia and febrile seizure in children. Med Glas (Zenica). 2012;9:239–242.
There are 34 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research
Authors

Ayşin Nalbantoğlu 0000-0002-5757-4051

Burçin Nalbantoğlu 0000-0002-5630-3399

Publication Date September 30, 2019
Acceptance Date February 24, 2019
Published in Issue Year 2019 Volume: 44 Issue: 3

Cite

MLA Nalbantoğlu, Ayşin and Burçin Nalbantoğlu. “Çocuklarda Demir eksikliğinin Febril konvülziyon Ile ilişkisi”. Cukurova Medical Journal, vol. 44, no. 3, 2019, pp. 1033-9.