Early Antipyretic Timing to Prevent Febrile Seizure Recurrence in Young Children with Pneumonia

Abstract

Background: Febrile seizure recurrence remains a concern in young children with acute infections, while conventional antipyretic administration has not consistently demonstrated preventive benefit. Whether earlier treatment during temperature elevation modifies short-term recurrence in children with pneumonia remains uncertain. Objective: To determine whether early paracetamol administration reduces febrile seizure recurrence compared with standard fever management in children with pneumonia and a previous simple febrile seizure. Methods: This parallel-group randomized controlled trial enrolled 120 children aged 6 months to 5 years at tertiary-care hospitals in Central Punjab, Pakistan. Participants were allocated equally to paracetamol initiated at 37.5°C or standard treatment initiated at ≥38.0°C and were monitored during hospitalization and for 14 days after discharge. Outcomes were evaluable for 113 participants. Results: Febrile seizure recurrence occurred in 4/57 (7.0%) early-treatment participants versus 12/56 (21.4%) controls (RR 0.33, 95% CI 0.11-0.95; p=0.028). Early treatment was associated with lower peak temperature (mean difference −0.60°C, 95% CI −0.77 to −0.43), fewer febrile episodes (−1.10, 95% CI −1.46 to −0.74), and shorter fever duration (−1.40 days, 95% CI −1.83 to −0.97). Hospital stay did not differ significantly. Conclusion: Among participants with evaluable follow-up, earlier paracetamol administration was associated with lower short-term febrile seizure recurrence and improved fever-related outcomes, although confirmation using complete intention-to-treat analyses is needed