Levels of Zinc and Iron Serum in Children with Febrile Seizures: Systematic Review and Meta-Analysis

Background: Febrile seizures are common in the paediatric population; the frequency of febrile seizures is significantly influenced by hereditary variables. Other variables, such as zinc and iron, may play an important role on the febrile seizures occurrence. This study aims to assess zinc and iron levels relation in febrile seizure children. Methods: Data sources published from PubMed, Proquest, Portal Garuda, and Web of Science published in 2000-2021 are carefully examined for relevant research published in English and Indonesian. We gathered and reviewed the total 30,849 journals. Only observational studies on the relationship between serum zinc and iron levels as well as the frequency of febrile seizures in children aged six months old to five years old had included. Analysis was on zinc and iron variables (SI, TIBC, and ferritin), and febrile seizures. Sensitivity analysis was performed after all the data were combined with a random effect or fixed effect model. Results: On 30 case-control studies with a total of 4,158 patients. From zinc examination, there were 15 studies with 922 patients with seizures with fever and 666 patients with fever without seizures. The results showed that patients with fever with seizures had lower zinc levels than patients with fever without seizures (SMD= -1.36 [-1.89, -0.84], p< 0.00001). On examination, ferritin and serum iron levels were found to be low compared to patients with fever without seizures, (SMD= -0.79 [-1.15, -0.43], p< 0.00001 and SMD= -0.60 [-1.04, -0.16], p=0.007). Studies of total iron binding capacity found a significant difference between patients with fever and seizure compared to the patients with fever but no seizure. Conclusion: Serum zinc and iron levels were low in febrile seizure children. This meta-analysis discovered a relationship between low zinc and iron levels and seizure in febrile children.