Clinico-laboratory profile of breath-holding spells in children in Sohag University Hospital, Upper Egypt

Sadek, Abdelrahim Abdrabou; Mohamed, Montaser M.; Sharaf, El-Zahraa El-Said Ahmed; Magdy, Rofaida M.; Allam, Ahmed

doi:10.19082/2227

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…Iron and B₁₂ deficiency are important causes of nutritional anemia in childhood. In this study, in accordance with the literature, ID was detected in 42 (58%) of the cases (14,16,19,24,25). The combination of BHS and ID was found to be higher in the 0-24-month group compared to the >24-month group.…”

Section: Discussionsupporting

confidence: 91%

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İbili¹

2023

Jour Umraniye Pediatr

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Objective: Breath holding spells (BHS) are common non-epileptic paroxysmal disorder in childhood. The aim of this study is to evaluate the clinical, laboratory, and treatment responses of patients followed up with BHS. Material and Methods: The files of 73 cases diagnosed with BHS in the Paediatric Neurology Outpatient Clinic of Afyonkarahisar Health Sciences University Hospital between December 2017 and January 2020 were evaluated retrospectively. Medical history, physical examination (PE), spell type (pallid, cyanotic, and mixed), spell degree (complicated and uncomplicated), family history, laboratory findings, electrocardiography, echocardiography, and electroencephalography findings were used. Results: Forty-one (56%) of the BHS cases were male and 32 (44%) were female. The mean age of the patients was 21.7±14.5 (min-max: 2-72) months. Forty-five cases (62%) under the age of 2 years were detected. There was a family history of BHS in 11 (15%) cases. PE was normal in 72 (99%) cases. Sixty-five (89%) of the cases were cyanotic, 5 (7%) were pallid type and 3 (4%) were mixed type. The complicated type was detected in 26 (36%) cases and the uncomplicated type in 47 (64%) cases. There were detected only iron deficiency (ID) in 42 (58%) cases, B 12 deficiency in 3 cases (4%), ID+B 12 deficiency in 14 cases (19%). Iron supplementation was given to 56 (75%) in cases, iron+B₁₂ treatment to 14 (19%) in cases, B₁₂ treatment to 3 (4%). The three cases who did not benefit with other treatments were given piracetam. There were 42 cases with ID. Thirty-one (73%) ID cases had a complete response to iron therapy, three ID cases (7%) had 50% or more response, and 2 cases (5%) had <50% response. Iron therapy had complete response in 14 (19%) cases without ID or B 12 deficiency. Complete response was obtained in 12 (86%) cases, 50% or more were obtained in 1 (7%), and <50% were obtained in 1 (7%) of the patients who received iron+B₁₂ treatment. Complete response was obtained in all patients treated with B₁₂ or piracetam. In the cyanotic cases, complete response was obtained in 43 (66%), 50% and above in 4 (6%), and <50% in 2 (3%). Complete response was obtained in all pallid type cases. Of the mixed type cases, complete response was obtained in 2 cases (66%) and 50% and above response in 1 case (34%). Conclusion: Patients with BHS was benefited from iron therapy, although there was no ID. In patients with B12 deficiency, B12 treatment had also been observed to reduce BHS. Although this finding is new information for the literature, B12 replacement treatment has also been observed to reduce BHS. This finding is new information for the literature. B12 replacement should be considered among the treatment options besides iron replacement.

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Section: Discussionsupporting

confidence: 91%

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İbili¹

2023

Jour Umraniye Pediatr

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“…Breath-holding spells in association with other types of anemia, including transient erythroblastopenia of childhood and sideroblastic anemia, have also been described [12, 31]. It has been shown that 7.5 to 69% of children with breath-holding spells have anemia [12, 32]. This is not surprising as the peak age of onset for both breath-holding spells and iron deficiency anemia is between 6 and 24 months old [1, 33].…”

Section: Etiopathogenesismentioning

confidence: 99%

“…Breath-holding spells may be classified as cyanotic or pallid, based on the coloration of the child's face (lips) during the event. Cyanotic breath-holding spells are by far the more common type, accounting for approximately 72% of cases [32]. There is considerable overlap in the clinical features of the two types of breath-holding spells.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence

Leung

Wong

et al. 2019

CPR

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Background: Breath-holding spells are common, frightening, but fortunately benign events. Familiarity with this condition is important so that an accurate diagnosis can be made.Objective: To familiarize physicians with the clinical manifestations, diagnosis, evaluation, and management of children with breath-holding spells.Methods: A PubMed search was completed in Clinical Queries using the key term “breath-holding spells”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.Results: Breath-holding spells affect 0.1 to 4.6% of otherwise healthy young children. The onset is usually between 6 and 18 months of age. The etiopathogenesis is likely multifactorial and includes autonomic nervous system dysregulation, vagally-mediated cardiac inhibition, delayed myelination of the brain stem, and iron deficiency anemia. Breath-holding spells may be cyanotic or pallid. The former are usually precipitated by anger or frustration while the latter are more often precipitated by pain or fear. In the cyanotic type, the child usually emits a short, loud cry, which leads to a sudden involuntary holding of the breath in forced expiration. The child becomes cyanosed, rigid or limp, followed by a transient loss of consciousness, and a long-awaited inspiration and resolution of the spell. In the pallid type, crying may be minimal or “silent”. The apneic period in the pallid type is briefer than that in the cyanotic type prior to the loss of consciousness and posture. The episode in the pallid type then proceeds in the same manner as a cyanotic spell except that the child in the pallid type develops pallor rather than cyanosis. In both types, the entire episode lasts approximately 10 to 60 seconds. The spells usually disappear spontaneously by 5 years of age.Conclusion: Although breath-holding spells are benign, they can be quite distressing to the parents. Confident reassurance and frank explanation are the cornerstones of treatment. Underlying cause, if present, should be treated. Interventions beyond iron supplementation may be considered for children with severe and frequent breath-holding spells which have a strong impact on the lifestyle of both the child and family.

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“…As we show during the BHAs EEG initially shows a slowing of the background activity and, as bradycardia deepens, further slowing of the cerebral activity manifests. As the consciousness was regained, the background EEG rapidly returned to normal 4 …”

Section: Discussionmentioning

confidence: 98%

“…BHA is commonly reported above the age of 6 months, but it should be considered also below this age, as this case and few other published cases demonstrate 2 . EEG is usually not needed for the diagnosis, but it could be useful when the semiology is unclear 3,4 …”

Section: Discussionmentioning

confidence: 99%

Ictal video‐electroencephalogram of breath‐holding attack

Dilena,

Biffi,

Mauri

et al. 2023

J Paediatrics Child Health

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Breath-holding attacks (BHAs) are non-epileptic paroxysmal events that affect 0.1% to 4.6% of infants from 6 months to 5 years of age. 1 Their frequency peaks at about 2 years of age and reduces by 5 years. The detailed description of the event is the key point for the diagnosis: the child typically emits a short loud cry, followed by breath holding, cyanosis, rigidity or limpness and transient loss of consciousness for a few seconds. Then, an inspiration marks the resolution of the spell. 1 The BHA are considered rare before 6 months of age, although they have been reported in the neonatal age. 2 BHA might be a frightening experience for parents, but its course is known to be benign. 1 Some patients have severe and frequent BHA up to five times per day, so their management can be complicated, especially when occurring under 6 months of age. Electroencephalogram (EEG) is used in specific cases to exclude tonic epileptic seizures. 3 Case HistorySince the age of 1 month and half an infant presented, usually during crying, episodes of apnea with cyanosis, and hypertonia, sometimes followed by hypotonia, pallor, loss of consciousness and finally sleep. For this reason, at 2 months of life, he was admitted to the hospital where physical, neurologic and cardiologic examination, brain ultrasound, standard EEG, blood cell count, serum ferritin level and electrocardiogram (ECG) showed no abnormalities. The infant was discharged with a diagnosis of BHA and a cardiorespiratory monitor was suggested.His medical history was remarkable for obstructive apnea due to gastroesophageal reflux disease and mild congenital laryngomalacia. His mother's history was unremarkable, except for exposure to a stressful event during pregnancy since, at 20 weeks of gestational age, fetal ultrasound showed shortness of long bones, suggesting a possible congenital disease. This event increased the anxious state of the mother already greatly upset by COVID-19 pandemic issues. However, the suspicion of congenital disease was ruled out.After discharge from the hospital, these episodes increased in intensity and frequency up to five times per day becoming so alarming that the patient was admitted to the Paediatric Intensive Care Unit (ICU) and Ambu bag ventilation was used during the episodes. The mother was frightened, fearing for the infant's life, so her capacity to console him was reduced. A long-term video EEG (vEEG) (Video S1) was performed, recording a typical event and demonstrating the non-epileptic nature of the paroxysmal event.After vEEG, resuscitation procedures with Ambu bag were stopped during the episodes and reassurance and psychological support was offered to the parents. In the following days, episodes decreased to 2 per day. Iron supplementation and piracetam 40 mg/kg divided in two daily doses was prescribed and in the following weeks the situation further improved. At 8 months of age he presented a normal development, BHA are still present although with minor manifestations, that the family has learned to manage.

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Clinico-laboratory profile of breath-holding spells in children in Sohag University Hospital, Upper Egypt

Cited by 7 publications

References 10 publications

Katılma nöbeti tedavisinde sadece demir desteği yeterli midir?

Katılma nöbeti tedavisinde sadece demir desteği yeterli midir?

Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence

Ictal video‐electroencephalogram of breath‐holding attack

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