Iron supplementation should be given in breath-holding spells regardless of anemia

Iron supplementation should be given in breath-holding spells regardless of anemia

Background/aim: The purpose of this retrospective study was to determine the effectiveness of oral iron therapy in breath-holdingspells and evaluation of electrocardiographical changes.Materials and methods: Three hundred twelve children aged 1–48 months and diagnosed with breath-holding spells between January2017 and April 2018 were included. Patients’ laboratory findings were compared with 100 patients who had one simple febrile seizure.Results: Cyanotic breath-holding spells were diagnosed in 85.3% (n = 266) of patients, pallid spells in 5.1% (n = 16), and mixed-type spells in9.6% (n = 30). Sleep electroencephalograms were applied for all patients, 98.2% (n = 306) of which were normal, while slow background rhythmwas determined in 1.2% (n = 4). Epileptic activity was observed in only 2 patients (0.6%). The mean hemoglobin (Hb) value in the breathholding spell group was 10.1 mg/dL. Patients’ mean corpuscular volume (MCV) was 73 fL. Patients’ Hb and MCV values were statisticallysignificantly lower than those of the control group (P < 0.001). The difference between spell burden was not statistically significant (P = 0.691).Spell burden decreased equally in both groups.Conclusion: Oral iron therapy can be administered in breath-holding seizures irrespective of whether or not the patient is anemic.

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  • 1. Swaiman, Kenneth F. Swaiman’s Pediatric Neurology: Principles and Practice. 5th ed. Edinburgh, UK: Elsevier Saunders; 2012.
  • 2. DiMario FJ Jr. Prospective study of children with cyanotic and pallid breath-holding spells. Pediatrics 2001; 107: 265-269.
  • 3. Carman KB, Ekici A, Yimenicioglu S, Arslantas D, Yakut A. Breath holding spells: point prevalence and associated factors among Turkish children. Pediatr Int 2013; 55: 328-331.
  • 4. Kuhle S, Tiefenthaler M, Seidl R, Hauser E. Prolonged generalized epileptic seizures triggered by breath-holding spells. Pediatr Neurol 2000; 23: 271-273.
  • 5. World Health Organization. The Global Prevalence of Anaemia in 2011. Geneva, Switzerland: WHO; 2011.
  • 6. Berger J, Dillon JC. Control of iron deficiency in developing countries. Sante 2002; 12: 22-30.
  • 7. Oski FA, Honig AS. The effects on the developmental scores of iron-deficient infants. J Pediatr 1978; 92: 21-25.
  • 8. Yilmaz U, Doksoz O, Celik T, Akinci G, Mese T, Yilmaz TS. The value of neurologic and cardiologic assessment in breath holding spells. Pak J Med Sci 2014; 30: 59-64.
  • 9. DiMario FJ, Sarfarazi M. Family pedigree analysis of children with severe breath holding spells. J Pediatr 1997; 130: 647-651.
  • 10. Arhan E, Sel K, Güven A, Değerliyurt A, Mutlu A, Keskin SK, Köse G. Retrospective evaluation of 220 children with breath holding spells. Turkish J Pediatr Dis 2009; 3: 5-11.
  • 11. Isıkay S. Katılma nöbeti olan 180 çocuk hastanın değerlendirilmesi. Turkiye Klinikleri J Pediatr 2014; 23: 53-58 (in Turkish).
  • 12. Laxdal T, Gomez MR, Reiher J. Cyanotic and pallid syncopal attacks in children (breath-holding spells). Dev Med Child Neurol. 1969; 11: 755-763.
  • 13. Holowach J, Thurston DL. Breath-holding spells and anemia. N Engl J Med 1963; 268: 21-23.
  • 14. Mocan MC, Mocan H, Aslan Y, Erduran E. Iron therapy in breath holding spells and cerebral erythropoietin. J Pediatr 1998; 133: 583-584.
  • 15. Jain R, Omanakuttan D, Singh A, Jajoo M. Effect of iron supplementation in children with breath holding spells. J Paediatr Child Health 2017; 53: 749-753.
  • 16. Bakoyiannis I, Gkioka E, Daskalopoulou A, Korou LM, Perrea D, Pergialiotis V. An explanation of the pathophysiology of adverse neurodevelopmental outcomes in iron deficiency. Rev Neurosci 2015; 26: 479-488.
  • 17. Masuda S, Okano M, Yamagishi K, Nagao M, Ueda M, Sasaki R. Novel site of erythropoietin production in cultured rat astrocytes. J Biol Chem 1994; 269: 19488-19493.
  • 18. Beard J. Iron deficiency and neural development: an update. Arch. Latinoam Nutr 1999; 49: 34S-39S.
  • 19. Youdim MB, Yehuda S. The neurochemical basis of cognitive deficits induced by brain iron deficiency: involvement of dopamine-opiate system. Cell Mol Biol 2000; 46: 491-500.
  • 20. Lozoff B, Jimenez E, Hagen J, Mollen E, Wolf A. Poorer behavioral and developmental outcome more than 10 years after treatment for iron deficiency in infancy. Pediatrics 2000; 105: E51.
  • 21. Deveci R, Gürbüz G, Acar S, Unalp A. Relationship of serum vitamin B12 levels, mean platelet volume and iron parameters of febrile convulsions in children. EC Paediatrics 2018; 7: 629- 637.
  • 22. Lombrosso CT, Lerman P. Breath holding spells (cyanotic and pallid infantile syncope). Pediatrics 1967; 39: 563-581.
  • 23. Daoud AS, Batieha A, al-Sheyyab M, Abuekteish F, Hijazi S. Effectiveness of iron therapy on breath-holding spells. J Pediatr 1997; 130: 547-550.
  • 24. DiMario FJ Jr, Burleson JA. Autonomic nervous system function in severe breath-holding spells. Pediatr Neurol 1993; 9: 268-274.
  • 25. Ergul Y, Otar G, Nisli K, Dindar A. Permanent cardiac pacing in a 2.5 month-old infant with severe cyanotic breath-holding spells and prolonged asystole. Cardiol J 2011; 18: 704-706.
  • 26. Kolkiran A, Tutar E, Atalay S, Deda G, Cin S. Autonomic nervous system functions in children with breath-holding spells and effects of iron deficiency. Acta Paediatr 2005; 94: 1227-1231.
  • 27. Tomoum H, Habeeb N, Elagouza I, Mobarez H. Paediatric breath-holding spells are associated with autonomic dysfunction and iron deficiency may play a role. Acta Paediatr 2018; 107: 653-657.
  • 28. Akalin F, Turan S, Gu T, Ayabakan C, Yilmaz Y. Increased QT dispersion in breath-holding spells. Acta Paediatr 2004; 93: 770-774.
  • 29. Donma MM. Clinical efficacy of piracetam in treatment of breath-holding spells. Pediatr Neural 1998; 10: 181-188.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: 6
  • Yayıncı: TÜBİTAK
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