Breath-holding Spells in Pediatrics: Clinicolaboratory Findings and Cardiac Repolarization Changes

Abstract

Breath-holding spells (BHS) are a benign common problem in young children. Autonomic nervous system dysregulation plays an important role in its pathogenesis. BHS may be associated with iron-deficiency anemia (IDA). The objective of the study was to explore the clinicolaboratory profile of children with BHS, electrocardiography (ECG), and echocardiography (ECHO) findings. The study included 50 children with breath-holding spells (BHS) and 50 controls, enrolled over 16 months. Clinical evaluation involved detailed history-taking, physical examination, and growth assessment. Laboratory investigations included complete blood count, serum iron, and serum ferritin levels. Electrocardiography (ECG) recordings were analyzed for corrected QT interval (QTc) and QTc dispersion (QTcd). Echocardiography (ECHO) studies were conducted to exclude primary cardiac diseases. Ethical approval was obtained, and statistical analysis was performed using SPSS version 26.”The study included 50 children with breath-holding spells (BHS) and 50 controls, enrolled over 16 months. Clinical evaluation involved detailed history-taking, physical examination, and growth assessment. Laboratory investigations, Electrocardiography (ECG) recordings and Echocardiography (ECHO) studies were conducted and were analyzed. The mean age of our children was 35 ± 20 months with their ages ranging from 11 to 84 months. Thirty-one children were male (62%) and 19 were female (38%). Cyanotic spells were present in 35 (70%) children, 7 (14%) children were of the pallid type, and 8 (16%) children were of the mixed type. Detailed history, laboratory tests (complete blood count, serum iron, and serum ferritin), ECG, and ECHO were done. Anemia was found in 66% of them (44% had IDA). The corrected QT interval (QTc) was 0.45 ± 0.02 s, 16% of children had prolonged QTc (>0.46 s), and QTc dispersion (QTcd) was 0.03 ± 0.02 s. We found a highly significant difference (P = 0.001) between cases and controls as regards QTc values, and no significant difference (P = 0.32) between the two groups as regards QTcd values. The cyanotic type is more common than the pallid and mixed types of BHS. IDA is a common finding in BHS. QTc is increased in children with BHS, which is a sign of cardiac repolarization changes. Therefore, the use of ECG for the diagnosis of rhythm abnormalities in these children is reasonable.