Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. 1221 (doi:10.1542/peds.2007-2536)

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LETTER TO THE EDITOR

Parental Attitude to Lumbar Puncture for Children With Fever and Seizure: In Reply

Allison Golnik, MD
Division of General Pediatrics
Department of Pediatrics
University of Minnesota
Minneapolis, MN 55455

I am grateful for the letter from Dr Habiba regarding parental acceptance of lumbar puncture (LP) and bandemia as a predictor of meningitis. The child in the case described had not received antibiotics before evaluation. Parental opposition to LP was one of the many factors that influenced the procedure decision. In addition, the clinical evaluation and debate surrounding the indications to perform LP in children aged 12 to 18 months with simple febrile seizure contributed to the decision.^1–5

Medical decision-making is increasingly shared by the physician and patient as equal partners.⁶ The American Academy of Pediatrics Committee on Bioethics has suggested that (when obtaining informed permission) physicians provide information in understandable language, consider the patient/parent's understanding and capacity to make necessary decisions, and assure the family that they have the freedom to choose between medical alternatives.⁶ If parents refuse a necessary procedure, physicians should focus on providing appropriate medical care and be prepared to seek legal intervention if the refusal places the child at substantial medical risk.⁶ Specifically, if parents refuse permission for LP, the American Academy of Pediatrics Committee on Bioethics suggested obtaining parental permission to initiate treatment on the basis of reasonable clinical judgment rather than postponing care or risking liability for performing the procedure without parental consent.⁶

Regarding the bandemia with neutrophil leukocytosis, bands indicate the rapid production of white blood cells and may be a predictor of bacterial meningitis.⁷ Bandemia with neutrophil leukocytosis should provoke strong consideration of a bacterial etiology (urinary tract infection, bacteremia, meningitis, etc). Such evidence of a bacterial etiology can be communicated to parents when discussing the risks and benefits of LP.

REFERENCES

1. Hampers LC, Thompson DA, Bajaj L, Tseng BS, Rudolph JR. Febrile seizure: measuring adherence to AAP guidelines among community ED physicians. Pediatr Emerg Care. 2006;22 :465 –469[CrossRef][Web of Science][Medline]
2. Nozicka C. Lumbar puncture and the first simple febrile seizure. Pediatrics. 1997;99 :306 –307[Free Full Text]
3. Green SM, Rothrock SG, Clem KJ, Zurcher RF, Mellick L. Can seizures be the sole manifestation of meningitis in febrile children? Pediatrics. 1993;92 :527 –534[Abstract/Free Full Text]
4. Carroll W, Brookfield D. Lumbar puncture following febrile convulsion. Arch Dis Child. 2002;87 :238 –240[Free Full Text]
5. Trainor JL, Hampers LC, Krug SE, Listernick R. Children with first-time simple febrile seizures are at low risk of serious bacterial illness. Acad Emerg Med. 2001;8 :781 –787[Web of Science][Medline]
6. American Academy of Pediatrics, Committee on Bioethics. Informed consent, parental permission, and assent in pediatric practice. Pediatrics. 1995;95 :314 –317[Abstract/Free Full Text]
7. Freedman SB, Marrocco A, Pirie J, Dick PT. Predictors of bacterial meningitis in the era after Haemophilus influenzae. Arch Pediatr Adolesc Med. 2001;155 :1301 –1306[Abstract/Free Full Text]

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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 Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science 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 Golnik, A. Search for Related Content PubMed Articles by Golnik, A. Related Collections Infectious Disease & Immunity Social Bookmarking                         What's this?