Abstract
Febrile seizures (FS) are common in children aged 6-60 months and often cause concern because of their potential association with central nervous system (CNS) infections like occult meningitis. While most FS are benign, distinguishing simple from complex cases is significant. This systematic review aims to evaluate the diagnostic utility and necessity of cerebrospinal fluid (CSF) analysis in young children presenting with FS to guide appropriate clinical decision-making. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines where literature was searched in PubMed, Cochrane Library, Web of Science, and Google Scholar (2015-2025) using terms related to FS, CSF analysis, and children aged 6-60 months. Inclusion criteria focused on observational studies that reported lumbar puncture. Two reviewers independently screened studies and extracted data on seizure type, age, and CSF results. Over 1,306 records were screened, and nine studies were included that involved 3,143 children aged 6-60 months. CSF analysis usage varied widely from over 6% to 100%. Bacterial meningitis was detected in 0.7-14% without clinical signs. High yield was among infants under 18 months. The risk of bias was low in most studies. CSF analysis in FS should be guided by age, vaccination status, and clinical signs. A selective approach avoids unnecessary lumbar punctures while ensuring serious CNS infections are not missed.