Paediatric breath‐holding spells are associated with autonomic dysfunction and iron deficiency may play a role

• Published in: Acta Paediatrica Vol. 107; no. 4; pp. 653 - 657
• Main Authors: Tomoum, H, Habeeb, N, Elagouza, I, Mobarez, H
• Format: Journal Article
• Language: English
• Published: Norway Wiley Subscription Services, Inc 01.04.2018
• Subjects: Anemia, Iron-Deficiency - complications; Anemia, Iron-Deficiency - diagnosis; Anemia, Iron-Deficiency - physiopathology; Autonomic dysfunction; Autonomic Nervous System Diseases - blood; Autonomic Nervous System Diseases - complications; Autonomic Nervous System Diseases - physiopathology; Bradycardia; Breath Holding; Breath‐holding spells; Case-Control Studies; Child; Child, Preschool; Children; Cross-Sectional Studies; Cyanosis - blood; Cyanosis - physiopathology; Dysautonomia; Dysrhythmias; Egypt; EKG; Electrocardiography; Female; Heart diseases; Humans; Infant; Iron; Iron - blood; Iron deficiency; Male; Nutrient deficiency; Egypt; Autonomic dysfunction; Breath-holding spells; Bradycardia; Iron; Dysrhythmias
• ISSN: 0803-5253; 1651-2227; 1651-2227
• DOI: 10.1111/apa.14177

Aim This study assessed cardiac performance and iron in subjects aged 12–36 months with breath‐holding spells (BHSs). Methods We consecutively recruited 40 subjects (55% male) experiencing BHSs from the general paediatric outpatients department at the Children's Hospital, Ain Shams University, Egypt, from 2015 to 2016. The 20 matched comparisons were mainly healthy siblings. The workup included iron levels and electrocardiograms. Results The age at the onset of BHSs was 5–24 months with a median monthly frequency of 13. Almost two‐thirds of the patients had cyanotic spells, and one‐third had pallid spells, lasting 25–90 seconds. Lower serum iron levels and higher QT dispersion and T‐wave dispersion were recorded in patients than the comparison group, and 4.8% had dysrhythmia and bradycardia. We observed higher durations of bradycardia during attacks and higher occurrences of dysrhythmia during cyanotic spells, which were more frequent in patients with prolonged or frequent BHSs. Conclusion Our study of patients aged 12–13 months supported the theory of autonomic dysfunction in BHSs. The ECG findings, especially in patients with prolonged or frequent spells, need to be studied further to evaluate the risk of life‐threatening events. Iron deficiency may play a role in autonomic dysfunction in patients with BHSs.