1 / 20

DO ANTIPYRETIC DRUGS PREVENT FEBRILE CONVULSIONS

DO ANTIPYRETIC DRUGS PREVENT FEBRILE CONVULSIONS. GILLIAN HAGGERTY PAC 1 DECEMBER 2009. Introduction . FEVER Increase in temperature caused by pyrogens acting on hypothalamus, ↑ temp set point → ↑ body temp Normal physiological response to infection (NICE 2007) FEBRILE SEIZURE

everly
Download Presentation

DO ANTIPYRETIC DRUGS PREVENT FEBRILE CONVULSIONS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DO ANTIPYRETIC DRUGS PREVENT FEBRILE CONVULSIONS GILLIAN HAGGERTY PAC 1 DECEMBER 2009

  2. Introduction FEVER • Increase in temperature caused by pyrogens acting on hypothalamus, ↑ temp set point → ↑ body temp • Normal physiological response to infection (NICE 2007) FEBRILE SEIZURE • Childhood seizure associated with fever • 3 – 5 % children 6/12 – 6yrs • 20 -30 % will have another • No long-term consequences (Moreno 2009)

  3. SIMPLE - <15mins, does not reoccur during illness. COMPLEX - >15mins, and/or several seizures during illness. RISK OF RECURRANCE • Young age at time of 1st seizure • Family history • Number of febrile episodes • Time lapse <6/12 since last seizure (Stuijvenberg et al 1998, Strengell et al 2009)

  4. Current Practice A recent influx of children to the ward following febrile convulsion has led to a review of our advice sheets, which in turn led to the question – are we offering the most up to date advice for parents? Current advice is to give regular antipyretic medication (paracetamol or ibuprofen) during febrile episodes to reduce the child's temperature and therefore lowering the risk of febrile convulsion recurrence. An opinion often expressed by both medical and nursing staff. However as APNPs it is important that we are providing our patients & carers with evidence based information.

  5. The question In children under 6yrs who have had a febrile convulsion does administration of paracetamol or ibuprofen compared to placebo prevent febrile seizure recurrence?

  6. Search Strategy Via Scottish eLibrary www.elib.scot.nhs.uk/ (accessed 23/11/09) Search Terms • Child* or paediatric or pediatric • Febrile or fever or pyrexia* • Convulsion or seizure or fit • Antipyretic or paracetamol or ibuprofen Cochrane Library - 18 reviews & 17 clinical trials Medline – 26 Embase – 27 NICE guidance management of feverish illness in <5yrs.

  7. Inclusion/Exclusion Criteria Included Antipyretic drugs – paracetamol, ibuprofen Randomised controlled trials Children under 6 years who have had febrile convulsion 1998 – present Excluded Epilepsy Anticonvulsant drugs CNS infection, meningitis From the search 2 articles fitted the criteria.

  8. CRITICAL APPRAISAL TOOL • Critical Appraisal Skills Programme (Casp) - 10 questions to help you make sense of randomised controlled trials from the Public Health Resource Unit (2006).

  9. WAS A CLEARLY FOCUSED QUESTION ASKED?

  10. WAS THIS A RANDOMISED CONTROL TRIAL?

  11. WERE THE PARTICIPANTS APPROPRIATELY ALLOCATED TO THE GROUPS?

  12. WERE PARTICIPANTS, STAFF & STUDY PERSONNEL BLIND?

  13. WERE ALL THE PARTICIPANTS WHO ENTERED THE TRIAL ACCOUNTED FOR AT ITS CONCLUSION?

  14. WERE THE PARTICIPANTS IN ALL GROUPS FOLLOWED UP & DATA COLLECTED IN THE SAME WAY?

  15. DID THE STUDY HAVE ENOUGH PARTICIPANTS TO MINIMISE THE PLAY OF CHANCE?

  16. HOW ARE THE RESULTS PRESENTED & WHAT IS THE MAIN RESULT?

  17. HOW PRECISE ARE THE RESULTS?

  18. WERE ALL IMPORTANT OUTCOMES CONSIDERED SO THE RESULTS CAN BE APPLIED?

  19. IMPLICATIONS FOR PRACTICE Although both studies found that paracetamol & ibuprofen were effective at reducing pyrexia, they were ineffective at reducing a pyrexia which occurs during episodes that led to a febrile convulsion. Therefore they are ineffective at preventing febrile seizure recurrence. As advanced nurse practitioners we should be ensuring that our colleagues are aware of this and that appropriate information is given to parents. That information being: while antipyretic drugs may still be administered during a febrile episode to make the child feel more comfortable they will not prevent a febrile convulsion from happening; ensure parents know the first aid of how to deal with one and reassure them of the relatively benign nature of febrile seizures (no long term consequences).

  20. References Moreno MA. (2009) Febrile Seizures in Children. Advice for Patients Archives of Pediatrics & Adolescent Medicine 163(9)872. NICE (2007) Feverish illness in children, assessment & initial management in children younger than 5 years. Guideline available from www.nice.org.uk (accessed 23/11/2009) Public Health Research Unit (2006). CASP 10 questions to help you make sense of randomised control trials. www.phru.nhs.uk/Pages/PHD/resources.htm Strengell T., Uhari M., Tarkka R., Uusimaa J., Alen R., Lautala P., Rantala H (2009) Antipyretic Agents for Preventing Recurrence of Febrile Seizures Archives of Pediatrics & Adolescent Medicine 163(9)799-804. Van Stuijvenberg M., Derksen-Lubsen G., Steyerberg E., Habbema J, Moll H., (1998) Randomized, Controlled Trial of Ibuprofen Syrup Administered During Febrile Illnesses to Prevent Febrile Seizure Recurrence Pediatrics 102(5)e51 (downloaded from www.pediatrics.org 26/11/09)

More Related