Children with febrile seizures (FS) have a small yet elevated risk for death. Recent data suggest that FS may contribute to sudden unexplained death in childhood (SUDC) among cases of sudden explained death in childhood (SEDC). This is according to findings published in JAMA Network Open from one of the largest studies of its kind exploring the role of FS and other risk factors in SUDC.
A total of 622 consecutive cases of sudden child death that occurred from 2001 to 2017 were included in the review. Data were collected from voluntary records of family members who were registered with the SUDC Foundation. The final cause of death resulted in cases categorized as either SEDC or SUDC. The main outcome measure included the certified manner of death as accident, natural, or undetermined.
Interviews documenting medical and social histories as well as circumstances of death (ie, SEDC vs SUDC) were carried out in 391 families with children age 1 to 6 years. In the overall case series, the mean age at time of death was 24.9 months. Of those who died, a total of 104 children (26.6%) had a history of FS. A higher prevalence of FS was observed among children with SUDC (28.8%; 95% CI, 23.3%-34.2%) and SEDC (22.1%; 95% CI, 14.8%-29.3%) compared with the general population (2%-5%). When compared with cases of SEDC, cases of SUDC had 4.6-fold higher odds for death occurring during sleep (95% CI, 1.92-11.09; adjusted P =.008). No report of premature death from SUDC was reported among the siblings of those with SUDC during the follow up period (3144 life-years).
A limitation of the study highlighted by the investigators was the lack of medical records or autopsy report reviews. They also point out that a reliance on interview data may have resulted in recall bias.
Although an elevated rate of FS was identified among SUDC and SEDC cases, the researchers indicate that “[t]o develop and assess preventive strategies for deaths associated with FS we need population-based studies to further define the epidemiology and risk factors and identify biomarkers of patients with FS who are at high risk of SUDC.”
Crandall LG, Lee JH, Stainman R, Friedman D, Devinsky O. Potential role of febrile seizures and other risk factors associated with sudden deaths in children. JAMA Netw Open. 2019;2(4):e192739.