8/12/2019 EBN PEDIA

1/5

Fernandez, John Michael

BSN403 Group 10

EVIDENCE-BASED NURSING

I. CLINICAL QUESTION:

Among pediatric clients, is an anti-pyretic drug more preferable than a continuous anti-epileptic drug in

treatment for febrile seizures?

II. CITATION:

Evidence-Based Management of seizure associated with fever. (Offringa, M & Moyer, V.)

III. STUDY CHARACTERISTICS:

a) Patients Included (population and sample)

406 children patients with a mean age of 24 months who had at least one febrile seizure.

b) Interventions compared

To determine whether prophylactic treatment with an antiepileptic drug or an antipyretic as compared with

no treatment decreases the likelihood of future febrile seizures, you are looking for studies in which

patients with febrile seizures were randomized to different treatment regimens and followed over time to

see how many developed subsequent febrile seizures.

Anti-pyretic drugs are drugs that reduce fever. They will not normally lower body temperature if one does

not have a fever. Antipyretics cause the hypothalamus to override an interleukin-induced increase in

temperature. The body will then work to lower the temperature and the result is a reduction in fever e.g.

Ibuprofen.

The anticonvulsants/ anti-epileptic drugs (AEDs) are a diverse group of pharmaceuticals used in the

treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of

bipolar disorder, since many seem to act as mood stabilizers. The goal of an anticonvulsant is to

suppress the rapid and excessive firing of neurons that start a seizure e.g. Diazepam.

8/12/2019 EBN PEDIA

2/5

c) Outcomes monitored

To avoid the adverse effects of giving antiepileptic drugs for prolonged periods, rapidly acting

anticonvulsants given only during fever periods have been used in an attempt to reduce the risk of

recurrent febrile seizures. Phenobarbitone given at times of fever has been proved ineffective, probably

because of the delay in achieving appropriate serum and tissue concentrations. Thus far, only

prophylactic diazepam, given orally or rectally, has been studied in placebo controlled trials. To assess

whether antipyretic drugs given intermittently prevent recurrence of febrile seizures, a randomized

placebo controlled trial was conducted in the Netherlands

d) Does the study focus on a significant problem in clinical practice?

The study didnt focus on the significant problem for clinical practice because the research we had

gathered encompasses a lot of researches that they barely able to conduct a thorough study in each onei.e. the relation to meningitis of febrile seizure, can physical examination determine solely the diagnosis of

the disease, and the possible occurrences of febrile seizures in a certain population.

IV. METHODOLOGY/ DESIGN:

a) Methodology used:

The methodology used is meta-analyses of randomized clinical trials and also other reports of

randomized clinical trials conducted outside of the study which is connected to the research being

studied.

b) Design:

The design used in conducting the research is a quantitative study with a randomized, double blind,

placebo controlled trial

c) Setting:

Emma Children'sHospital, AcademicMedical Center,University ofAmsterdam,1105 AZ

Amsterdam,Netherlands

Department of Pediatrics, University of Texas, Houston Health Science Center, Houston,

Texas, 77030, USA

8/12/2019 EBN PEDIA

3/5

d) Data Sources:

PubMed: Clinical queriestherapysensitivity seizures and fever and recurrence

Medline (PubMed: www.ncbi.nih.gov/entrez/static/clinical.html): Clinical queriesaetiology

sensitivity: fever and seizures andmeningitis

e) Subject Selection:

a. Inclusion Criteria:

1. Children 1 month13 yrs. old.

2. Have a history of at least one (1) febrile seizure

b. Exclusion Criteria:

1. Have a history of bacterial meningitis.

2. Children 1418 yrs. old.

f) Has the original study been replicated?

The original study has been replicated, as I have said earlier, this study is a compilation of all the meta-

analyses of randomized clinical trials.

g) What were the benefits of the nursing intervention tested in the study?

This will depend on the values they place on different outcomes such as risk of a subsequent seizure and

the adverse effects of use of anticonvulsants. You counsel these parents that the risk of recurrence

declines rapidly after six months from the previous seizure and instruct them to position the child for

optimal airway patency in case of a new seizure, which is especially important in the event of vomiting.

V. RESULTS OF THE STUDY:

Diazepam - Rosman et al conducted a randomized, double blind, placebo controlled trial among 406

children with a mean age of 24 months who had had at least one febrile seizure, comparing diazepam

(0.33 mg per kg body weight), given orally every eight hours during febrile illnesses, with placebo. 11

During a mean follow up of two years, the relative risk of subsequent febrile seizures per person year was

0.56 (0.38 to 0.81). Many parents did not give the treatment as directed, and an analysis restricted to

children who had seizures while definitely receiving the study drug showed an 82% reduction in the risk of

febrile seizures with diazepam.

8/12/2019 EBN PEDIA

4/5

Between 25% and 30% of the children in the study by Rosman were irritable, lethargic, or ataxic after

taking diazepam, which might interfere with parents' and clinicians' ability to distinguish benign childhood

febrile illness from more serious disease; one in every 3.54 children taking diazepam develops these

symptoms (number needed to harm= 3.54). The decision to recommend this treatment will depend on

balancing these potential harms against the potential benefits to each specific child, and on the family's

values.

Ibuprofen to assess whether antipyretic drugs given intermittently prevent recurrence of febrile seizures, a

randomized placebo controlled trial was conducted in the Netherlands. 12 Children aged 1 to 4 years who

had at least one risk factor for recurrence of a febrile seizure were randomly assigned to receive either

ibuprofen syrup, 5 mg per kg body weight per dose, or placebo every six hours during fever, defined as a

temperature > 38.4C. Median follow up time was 12 months. The relative risks for recurrence in the two

groups did not differ significantly.

VI. AUTHORS CONCLUSION/ RECOMMENDATION:

a) What contribution to the client health status does the nursing action/intervention

make?

The health care team should decide with the patient and his/her support system that the evidence does

not support using a daily anticonvulsant like phenobarbitone or sodium valproate, and that intermittent

diazepam or an antipyretic agent during fever are not effective in pre venting recurrence of seizures.

Both parties know that the patient with febrile seizure will need to spend time with the parents to help

them overcomethe fears and anxiety that seizures provoke and toeducate them about the clinical course

of febrileseizures and their consequences. (Offringa, M & Moyer, V.)

b) What overall contribution to nursing knowledge does the study make?

This will depend on the values they place on different outcomes such as risk of a subsequent seizure and

the adverse effects of use of anticonvulsants. You counsel these parents that the risk of recurrence

declines rapidly after six months from the previous seizure and instruct them to position the child for

optimal airway patency in case of a new seizure, which is especially important in the event of vomiting. Aprescription for rectal diazepam should also be given, and the parents should be instructed how to

administer it in the rare event of a prolonged recurrence lasting > 15 minutes.17 18 this approach, it has

been suggested, also reduces parental fear.

8/12/2019 EBN PEDIA

5/5

VII. APPLICABILITY:

a) Does the study provide a direct enough answer to your clinical question in terms

of type of patients, interventions and outcomes?

The study does not provide a direct answer to the clinical question being asked, in terms of interventions

and outcomes, but the patients included are in the same terms.

b) Is it feasible to carry out the nursing action in the real world?

The study conducted above is not yet feasible enough to be carried out as a nursing action due to the

fact that it doesnt directly answer the clinical question being asked.

VIII.REVIEWERS CONCLUSION/ COMMENTARY:

The research above is good in terms of generability but is not good enough and needs more research to

be applicable to nursing action and application in the real world and not feasible to be carried out in the

nurse and patient setting. The research conducted was only based on meta-analyses of randomized

clinical trials which are only the compilation of researches with conducted clinical trials in different settings

that come up a study.