Background: The occurrence of seizures in bacterial meningitis is important, as it has been reported to increase the risk of complications; however, its frequency and predictors are not well studied yet. Objective: To assess the frequency, clinical, and biochemical predictors of seizures in children with acute bacterial meningitis. Method: A cross-sectional study recruited confirmed acute bacterial meningitis cases based on positive CSF culture and sensitivity among children aged 2 months to 15 years admitted to the Central Child Teaching Hospital emergency department in Iraq. Patients were divided into two groups based on seizure at presentation time. Demographic characteristics [age, gender, residence, duration of fever and disease, presenting complaints and antibiotic intake]; hematological [WBC, neutrophils] Lymphocyte, N/L ratio, packed cell volume, platelets, blood sugar, and cerebrospinal fluid (CSF) indices were compared between groups. Results: Seizures had a frequency of 18% among the 122 children and were significantly higher in younger cases with female predominance. By multivariate analysis and odds ratio (OR), predictors for seizure were as follows: CSF lymphocytes (OR=0.25, 95%CI=0.08–0.26), lethargy (OR=8.15, 95%CI=1.03-68.65), headache (OR=0.09, 95%CI=0.02-0.45), neck stiffness (OR=0.07, 95% CI=0.01-0.61) and poor feeding (OR=4.8, 95%CI=1.21–18.97). Conclusions: CSF lymphocytes reliably predicted seizure with good sensitivity and specificity of 75% and 73%. Lethargy and poor feeding had the highest odds as clinical predictors of seizures. Together, those results can help with risk stratification and allocate resources for high-risk cases to improve patient outcomes
