Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. 1220 (doi:10.1542/10.1542/peds.2007-2368)

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LETTER TO THE EDITOR

Parental Attitude to Lumbar Puncture for Children With Fever and Seizure

Ayman Habiba, MD
Consultant Pediatrician
Al Mowasat Hospital
Salmiya 22077, Kuwait

To the Editor.—

I read with interest the case presented by Golnik¹ of a 1-year-old girl with pneumococcal meningitis who presented with fever and a febrile seizure. It can be inferred, although it was not mentioned explicitly, that the child in this case report had not received antibiotics for any other reason during the days preceding her presenting illness.

In the presence of a negative blood-culture result, lumbar puncture proved to be the crucial diagnostic test. Parental opposition, despite a discussion of the risks and benefits of the procedure, caused a delay in the initiation of antibiotic treatment, which could have resulted in more serious long-term consequences. The way physicians introduce lumbar puncture to parents, not as a mere option but as a crucial diagnostic procedure in this and similar instances, could be an important determinant of their acceptance. While mentioning the risks of the procedure itself (which should, in experienced hands, be exceedingly low), perhaps more importantly, the risks of not performing it in such a situation have to be stressed. How can we do better when it comes to convincing parents of the necessity of performing such a procedure in a timely fashion, and what should we do if they remain opposed?^2–5 Should we err on the side of caution and start treatment for presumed meningitis, or is watchful waiting, as done in this case, the only option?

This child had a neutrophil leukocytosis with an elevated percentage of bands on her initial blood count. In retrospect, although the initial clinical picture was in favor of a viral illness, such neutrophil leukocytosis, particularly in the presence of a left shift, might have been one indicator of a bacterial illness. Could such leukocytosis with a left shift, even in the absence of atypical seizure or any other clinical signs of meningitis, have added to the weight of evidence in support of performing a lumbar puncture, tipping the benefit/risk equation in favor of a lumbar puncture from a parent's perspective?

REFERENCES

1. Golnik A. Pneumococcal meningitis presenting with a simple febrile seizure and negative blood culture result. Pediatrics. 2007;120(2) . Available at: www.pediatrics.org/cgi/content/full/120/2/e428
2. Botkin JR. Informed consent for lumbar puncture. Am J Dis Child. 1989;143 :899 –904[Abstract/Free Full Text]
3. Beresford HR. Informed consent before lumbar puncture. N Engl J Med. 1980;303 :1534[Web of Science][Medline]
4. Ling SG, Boey CC. Lumbar puncture refusal in febrile convulsions. Singapore Med J. 2000;41 :485 –488[Medline]
5. Deng CT, Zulkifli HI, Azizi BH. Parents' views of lumbar puncture in children with febrile seizures. Med J Malaysia. 1994;49 :263 –268[Medline]

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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Habiba, A. Search for Related Content PubMed PubMed Citation Articles by Habiba, A. Related Collections Infectious Disease & Immunity Social Bookmarking                         What's this?