Retrospective Review of Iron Deficiency Profiles in Toddlers Presenting With Their First Febrile Seizure

Abstract

Background: Febrile seizures are common neurological events in early childhood, and iron deficiency has been proposed as a biologically plausible contributor to altered neuronal excitability because of its role in neurodevelopment, neurotransmitter synthesis, and cerebral energy metabolism. Objective: To determine whether iron deficiency profiles are associated with prolonged seizure duration among toddlers presenting with their first febrile seizure. Methods: This retrospective observational analytical study reviewed electronic medical records, archived laboratory reports, and paediatric emergency registers from tertiary care hospitals in Central Punjab for children aged 6–36 months presenting with first documented febrile seizure between January 2022 and December 2024. After exclusions, 132 eligible records were analyzed. Iron status was categorized as normal iron status, depleted iron stores, latent iron deficiency, or iron deficiency anemia using integrated hematological indices. Statistical analysis included descriptive statistics, chi-square testing, ANOVA, and binary logistic regression adjusted for age, sex, nutritional status, family history, and peak presenting temperature. Results: Depleted iron stores were identified in 42 children (31.8%), latent iron deficiency in 36 (27.3%), iron deficiency anemia in 29 (22.0%), and normal iron status in 25 (18.9%). Mean seizure duration increased progressively from 3.1 ± 1.2 minutes in children with normal iron status to 5.6 ± 2.0 minutes in those with iron deficiency anemia. Seizures lasting longer than five minutes increased from 12.0% to 48.3% across the same spectrum. Iron profile was significantly associated with prolonged seizure duration (χ² = 11.82; p = 0.008), with latent iron deficiency (adjusted OR = 2.18; 95% CI: 1.04–4.55; p = 0.038) and iron deficiency anemia (adjusted OR = 2.94; 95% CI: 1.31–6.58; p = 0.009) independently associated with higher odds of prolonged seizure. Conclusion: Worsening iron deficiency profiles were significantly associated with prolonged first febrile seizure duration in toddlers, suggesting that latent and overt iron deficiency may represent clinically relevant markers of greater seizure severity during febrile illness