Breath holding spells : impact of iron therapy

Abstract EN

Background : Breath holding spells (BHS) are a well recognized, common problem affecting about 4.

5 % of healthy children.

The pathophysiologic mechanism and treatment of breath-holding spells remain controversial.

Some authors have suggested the presence of an underlying autonomic nervous system dysfunction in children with BHS ; others observed the presence of concomitant iron deficiency anemia in these children. Aims : This study was done to evaluate the effect of iron therapy on children with BHS and iron deficiency anemia, also to compare the outcome of these patients with those without any abnormality in their iron indices. Methods : 105 children with BHS were enrolled in the study.

Age range from 3 to 36 months was included.

Detailed medical and family history was taken.

The type and frequency of the attacks were recorded.

Electroencephalography and electrocardiography were done for all patients to exclude epilepsy or patients with prolonged QT interval.

All patients were evaluated initially for hematological indices.

They were classified accordingly ; 75 patients were found to have BHS with iron deficiency anemia and were treated with iron for three months.

Other patients had normal indices and were not given any treatment.

All haematological indices were repeated three months and the response to therapy was evaluated.

Results : 105 patients with breath holding spells, (63) males and (42) females, with a male to female ratio of 1.

5 : 1 were included.

The median age at presentation was 16 months and ranged from 10 to 32 months.

71 % bf our patients were under 18 months.

Positive family history and positive consanguinity were found in 19% and 18 % of our patients respectively.

Cyanotic attacks were the predominant type (59 %) and the most common frequency of spells was from 10-30/month (47 %) followed by less than 10/month (44 %).

Children treated with iron showed significant reduction in the frequency of BHS.

Complete recovery occurred in (52 %) compared with (16.

7 %) in the non treated group arid partial improvement in 32 % compared to 23.

3 % in the non treated group.

Blood indices of all patients with iron deficiency anemia became normal after iron treatment.

Conclusion : Our results show that iron deficiency is an important risk factor in BHS and that iron therapy is helpful in the treatment of BHS.

Iron-deficient patients are more likely to benefit from iron treatment than patients who are not iron deficient.