Long-term recurrence and acute seizure clustering in children with convulsions with mild gastroenteritis: a systematic review and meta-analysis
摘要
To evaluate acute and long-term recurrence in children with convulsions with mild gastroenteritis (CwG) and to identify candidate factors associated with long-term relapse. This PRISMA 2020–compliant systematic review and meta-analysis (PROSPERO CRD420261348817) searched five databases from inception to March 25, 2026. Observational studies of children with CwG reporting recurrence-related outcomes were included. Random-effects models were used for all pooled analyses. Twenty-one studies (3,302 participants) were included. The primary pooled long-term relapse rate was 9.8% (95% CI 5.2%–17.7%; I2 = 88.5%); a sensitivity analysis excluding two studies with broader recurrence definitions yielded 6.1% (95% CI 4.9%–7.5%; I2 = 0.0%). Age below 18 months (OR 3.99, 95% CI 1.78–8.91; I2 = 0.0%) and family history of convulsions (OR 4.74, 95% CI 2.23–10.06; I2 = 0.0%) were each associated with long-term recurrence in exploratory pooled analyses of crude odds ratios from two studies. Acute multiple seizures occurred in 57.2% of children (95% CI 47.0%–66.9%; I2 = 86.5%); children with multiple seizures were younger (mean difference − 3.41 months, 95% CI − 6.06 to − 0.75) and had lower serum sodium (− 1.30 mmol/L, 95% CI − 2.42 to − 0.17) than those with a single seizure. Conclusion: Long-term relapse occurred in approximately 6%–10% of children with CwG, depending on the recurrence definition (9.8% primary estimate; 6.1% sensitivity estimate). Age below 18 months and family history were each associated with relapse in exploratory two-study analyses; given crude, unadjusted estimates and very low certainty, these should be regarded as hypothesis-generating candidate factors rather than validated predictors.