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Iron deficiency and cyanotic breath-holding spells: The effectiveness of iron therapy
Sherifa A Hamed1, Eman Fathalla Gad2, Tahra Kamel Sherif3
1a Department of Neurology and Psychiatry , Assiut University Hospital , Assiut , Egypt.
Insights
Frequent cyanotic breath holding spells in children are linked to iron deficiency, even without anemia. Iron therapy significantly reduces spell frequency, highlighting the importance of iron levels in managing these episodes.
Area of Science:
- Pediatrics
- Hematology
- Child Neurology
Background:
- Cyanotic breath holding spells (BHS) are common in children and cause significant parental anxiety.
- Iron deficiency and iron deficiency anemia are potential contributing factors to BHS, but their specific roles require further evaluation.
Purpose of the Study:
- To investigate the clinical, laboratory, and treatment characteristics of children experiencing frequent cyanotic BHS.
- To determine the association between iron status (deficiency and anemia) and the frequency of cyanotic BHS.
- To evaluate the efficacy of iron therapy in reducing the frequency of cyanotic BHS.
Main Methods:
- A cohort of 180 children with cyanotic BHS was analyzed, categorized into groups based on iron deficiency and iron deficiency anemia.
- Blood hemoglobin, ferritin, and iron levels were measured at baseline and after 3 and 6 months of iron treatment.
- Spell frequency was recorded and correlated with iron status and treatment outcomes.
Main Results:
- 61% of children with frequent cyanotic BHS had iron deficiency or iron deficiency anemia (p=0.001).
- Iron therapy led to a significant reduction in spell frequency and improved hemoglobin, ferritin, and iron levels (p=0.0001).
- Spell frequency showed negative correlations with hemoglobin, ferritin, and iron levels (p≤0.001).
Conclusions:
- Iron deficiency, even in the absence of anemia, is associated with a higher risk of frequent cyanotic BHS.
- Iron supplementation is an effective treatment for reducing the frequency of cyanotic BHS in affected children.
- Monitoring and correcting iron status should be considered in the management of children with frequent cyanotic BHS.
Abstract:
Aim: Frequent cyanotic breath holding spells cause fear and severe anxiety to parents. This study aimed to evaluate clinical, laboratory and treatment characteristics of children with cyanotic breath holding spells. Methods: Included were 180 children (mean age: 1.82 ± 0.53 years) with cyanotic breath holding spells. They were divided into three groups: with iron deficiency, with iron deficiency anemia and without iron deficiency. Blood hemoglobin (HB), ferritin and iron concentrations were measured at baseline and after 3 and 6 months of iron treatment. Results: The mean spell frequency was 24.57 ± 7.31/months, 83% had spells after the age of 1 year, 37% had daily spells, 16% had family history of spells, and 61% had Iron deficiency/Iron deficiency anemia (p = .001). No significant difference in the frequency of spells between children with iron deficiency and those with Iron deficiency anemia. Compared to patients without iron deficiency, there was significant reduction of spells frequency, increased hemoglobin, ferritin and iron levels after 3 and 6 months of iron therapy (p = .0001). Negative correlations were observed between spell frequency with hemoglobin (p = .001), ferritin (p = .0001) and iron (p = .001) levels. Conclusion: Not only Iron deficiency anemia but also iron deficiency alone without anemia is associated with a risk of high-frequency cyanotic breath holding spells. Iron therapy results in reduction in spells' frequency which was correlated with increasing ferritin and iron levels.
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