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- Title
Potential Role of Febrile Seizures and Other Risk Factors Associated With Sudden Deaths in Children.
- Authors
Crandall, Laura Gould; Lee, Joyce H.; Stainman, Rebecca; Friedman, Daniel; Devinsky, Orrin
- Abstract
Key Points: Question: Are febrile seizures associated with increased risk of sudden deaths in young children, and could febrile seizures contribute to some deaths? Findings: In this case series of 391 children from 18 countries, febrile seizure rates were increased among both sudden explained and sudden unexplained deaths compared with the general population, suggesting that seizures contributed to some of these deaths. No sudden deaths occurred in more than 3100 life-years among siblings of children with sudden unexplained death. Meaning: Patients with febrile seizures are at increased risk for sudden death, but the risk is small; identifying clinical features or biomarkers of high risk is essential to develop and assess preventive strategies. Importance: Sudden unexplained death in childhood (SUDC) is the fifth leading category of death among toddlers but remains underrecognized and inadequately studied. Objective: To assess the potential role of febrile seizures (FS) and other risk factors associated with SUDC and describe the epidemiology, mechanisms, and prevention of SUDC. Design, Setting, and Participants: This case series study reviewed 622 consecutive sudden child death cases aged 1 to 17 years from 2001 to 2017 from 18 countries. Data were collected from family members of children who died suddenly; these families voluntarily registered with the SUDC Foundation. Data analysis was conducted from November 2017 to February 2019. Main Outcome Measures: Certified manner of death characterized as accident, natural, or undetermined. Results: A total of 391 families with decedents aged 1 to 6 years completed a comprehensive interview on medical and social histories, and circumstances of death with forensic evaluations revealing a cause of death (sudden explained death in childhood [SEDC]) or no cause of death (SUDC). Of these children, 231 (59.1%) were male, the mean (SD) age at death was 24.9 (12.8) months, and 104 (26.6%) had a history of FS. Compared with the general population FS prevalence (2%-5%), FS prevalence among SUDC (28.8%; 95% CI, 23.3%-34.2%) and SEDC (22.1%; 95% CI, 14.8%-29.3%) were elevated. The odds of death during sleep was 4.6-fold higher in SUDC than in SEDC cases (odds ratio, 4.61; 95% CI, 1.92-11.09; adjusted P =.008). The siblings of SUDC cases were followed up for 3144 life-years, and none died prematurely from SUDC. Conclusions and Relevance: This analysis of the largest SUDC cohort confirmed an increased FS rate and found significantly increased rates of FS among SEDC. This study suggests that seizures may contribute to some SUDC and SEDC deaths. The risk of sudden death in a sibling was low. To develop and assess preventive strategies, population-based studies are needed to define the epidemiology and spectrum of risk factors and identify biomarkers of patients with FS at high risk of sudden death. This case series study assesses the potential role of febrile seizures and other risk factors associated with sudden death in childhood and describes the epidemiology, mechanisms, and prevention of sudden death in childhood.
- Subjects
SUDDEN death prevention; FAMILIES &; psychology; SUDDEN death -- Risk factors; CHI-squared test; CONFIDENCE intervals; CAUSES of death; FEBRILE seizures; INTERVIEWING; RESEARCH funding; STATISTICS; T-test (Statistics); DATA analysis; DESCRIPTIVE statistics; ODDS ratio; DISEASE complications; CHILDREN
- Publication
JAMA Network Open, 2019, Vol 2, Issue 4, pe192739
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2019.2739