Association of breath-holding attacks with anaemia and their treatment – documents anoxia tisular

INDIAN JOURNAL OF PEDIATRICS

May, 1964 vol. 31 no. 196

ASSOCIATION OF BREATH-HOLDING ATTACKS

ANAEMIA AND THEIR TREATMENT*

R. K. CHANDRA

Chandigarh

WITH

Breath-holding spells are a dramatic

Expression of an infant’s reaction to

Stressful conditions. Anaemic children

Are known to be more irritable and thus

Prone to psychological upsets. Thinking

Along these lines, we became aware of the

Frequent association of a significant

Degree of anaemia in children brought to

Our clinic with the complaint of breath-

Holding episodes.

The study

Thirty-six children with a history of

Having had breath-holding spells in the

Previous three months were studied as


Regards haemoglobin level and red cell

Morphology, to estimate the degree and

anoxia tisular

Type of anaemia. In addition, 15 epileptic

Children, nine with febrile convulsions and

30 normal infants were examined.

The results are shown in table I.

Infants with a history of breath-holding

Spells were distributed mainly in the low

Haemoglobin range, as contrasted with the

Other groups studied. The differential

Distribution is statistically significant.

(p,

144 INDIAN JOURNAL OF PEDIATRICS VOI.. 31 no. Lc6

Table 1. Haemoglobin levels hl various groups of children studied

Group

Haemoglobin (gin %)

More than

12 10–11.9 8–9.9 6–7.9 4–5.9

1 . Normal infants 5 20 4 1

2. Infants with history of breath-

Holding spells I 5 I 1 16

3. Epileptic children – – 10 3 2

4. Infants with febrile convulsions 2 5 2 – –

Conditioned reflex, hereditary neuro-

anoxia tisular

Pathic disposition, disturbed mentality,

Vagotonia, and cerebral anoxia are some

Of the factors postulated to be opera-

Tive3’4’e.. SCHARPEY-SCHAFER et al 5. Ob-

Served a fall in blood pressure due to

Increase in intrathoracic pressure, in-

Creased muscle blood flow and raised

Cerebral vascular resistance. All these

Factors could produce a diminution in

Effective cerebral blood flow. Recently,

GAUK, KIDD and PRICHARD -~ showed a

Fall in arterial oxygen saturation.

Anaemia would aggravate the situation by

A reduced oxygen carrying capacity of

Blood, thus making the infant more prone

To cerebral hypoxemia and convulsions.

Such a patho-physiologic dysfunction

Could be expected to be reversed once the

Oxygen carrying capacity of blood is

anoxia tisular

Brought up with haematinics. Results of

The present study show that correction of

Anaemia is very helpful in effective

Management of infants with breath-

Holding spells.

Summary

The association of anaemia and breath-

Holding spells is reported and its implica-

Tions in explaining the pathophysiology

Of the attacks mentioned. The role of

Antianaemic therapy in management of

Such infants is shown.

Addendum

After preparation of the manuscript, the paper

By J. HOLOWACtI and D. L. THURSTON (new en.GL

J. J~ied., 268 : 21, 1963), has come to our notme.

The authors found that 23.5 per cent of infants

With history of breath-holding spells had haemo-

Globin less than 7.9 gm. Per cent, compared with

6.9 per cent incidence of such a degree of anaemia

anoxia tisular

Among hospital admissions and 2.6 per cent in

Cases with myoclonic and febrile seizures. The

Authors have not attempted correction of anaemia

As a possible therapeutic measure, in addition to

Re-assurance of the parents, for relief of breath-

Holding attacks.

Re ferences

1. BRIDGE. E. M., LIVINGSTON, S., and TIETZE, C.

–breath-holding spells : their relationship

To syncope, convulsions and other phenomena.

J. Pediat.. 23 : 539, 1943.

2. GAUK, E. W., KIDD, L., and PRICHARO, J. S. – –

Mechanism of seizures associated with breath-

Holding spells. New engl. D. Med., 268:

1436, 1963.

3. HINMA~, A., and DICKEY, L. B.–breath-

Holding spells : A review of literature with

11 additional cases. Amer. J. Dis. Child.,

91 : 23, 1956.Anoxia tisular

4. KA~NFR, L.–child psychiatry. Thomas,

Springfield. P. 393, 1957.

5. SCllARPEY-SCHAFER, E. P., HOWARD, P.,

LEATHART, G. L., and DORNHURST, A. C . – –

The faint ing lark and the mess trick.

Brit. Reed. J. 2 : 382, 1951.

6. VULLIAMY, D. G.–breath-holding attacks.

Practitioner. 177 : 517. 1996.

INDIAN JOURNAL OF PEDIATRICS

May, 1964 vol. 31 no. 196

ASSOCIATION OF BREATH-HOLDING ATTACKS

ANAEMIA AND THEIR TREATMENT*

R. K. CHANDRA

Chandigarh

WITH

Breath-holding spells are a dramatic

Expression of an infant’s reaction to

Stressful conditions. Anaemic children

Are known to be more irritable and thus

Prone to psychological upsets. Thinking

Along these lines, we became aware of the

Frequent association of a significant

anoxia tisular

Degree of anaemia in children brought to

Our clinic with the complaint of breath-

Holding episodes.

The study

Thirty-six children with a history of

Having had breath-holding spells in the

Previous three months were studied as

Regards haemoglobin level and red cell

Morphology, to estimate the degree and

Type of anaemia. In addition, 15 epileptic

Children, nine with febrile convulsions and

30 normal infants were examined.

The results are shown in table I.

Infants with a history of breath-holding

Spells were distributed mainly in the low

Haemoglobin range, as contrasted with the

Other groups studied. The differential

Distribution is statistically significant.

(p,

144 INDIAN JOURNAL OF PEDIATRICS VOI.. 31 no. Lc6

anoxia tisular

Table 1. Haemoglobin levels hl various groups of children studied

Group

Haemoglobin (gin %)

More than

12 10–11.9 8–9.9 6–7.9 4–5.9

1 . Normal infants 5 20 4 1

2. Infants with history of breath-

Holding spells I 5 I 1 16

3. Epileptic children – – 10 3 2

4. Infants with febrile convulsions 2 5 2 – –

Conditioned reflex, hereditary neuro-

Pathic disposition, disturbed mentality,

Vagotonia, and cerebral anoxia are some

Of the factors postulated to be opera-

Tive3’4’e.. SCHARPEY-SCHAFER et al 5. Ob-

Served a fall in blood pressure due to

Increase in intrathoracic pressure, in-

Creased muscle blood flow and raised

Cerebral vascular resistance. All these

Factors could produce a diminution in

Effective cerebral blood flow.Anoxia tisular recently,

GAUK, KIDD and PRICHARD -~ showed a

Fall in arterial oxygen saturation.

Anaemia would aggravate the situation by

A reduced oxygen carrying capacity of

Blood, thus making the infant more prone

To cerebral hypoxemia and convulsions.

Such a patho-physiologic dysfunction

Could be expected to be reversed once the

Oxygen carrying capacity of blood is

Brought up with haematinics. Results of

The present study show that correction of

Anaemia is very helpful in effective

Management of infants with breath-

Holding spells.

Summary

The association of anaemia and breath-

Holding spells is reported and its implica-

Tions in explaining the pathophysiology

Of the attacks mentioned. The role of

Antianaemic therapy in management of

anoxia tisular

Such infants is shown.

Addendum

After preparation of the manuscript, the paper

By J. HOLOWACtI and D. L. THURSTON (new en.GL

J. J~ied., 268 : 21, 1963), has come to our notme.

The authors found that 23.5 per cent of infants

With history of breath-holding spells had haemo-

Globin less than 7.9 gm. Per cent, compared with

6.9 per cent incidence of such a degree of anaemia

Among hospital admissions and 2.6 per cent in

Cases with myoclonic and febrile seizures. The

Authors have not attempted correction of anaemia

As a possible therapeutic measure, in addition to

Re-assurance of the parents, for relief of breath-

Holding attacks.

Re ferences

1. BRIDGE. E. M., LIVINGSTON, S., and TIETZE, C.

–breath-holding spells : their relationship

anoxia tisular

To syncope, convulsions and other phenomena.

J. Pediat.. 23 : 539, 1943.

2. GAUK, E. W., KIDD, L., and PRICHARO, J. S. – –

Mechanism of seizures associated with breath-

Holding spells. New engl. D. Med., 268:

1436, 1963.

3. HINMA~, A., and DICKEY, L. B.–breath-

Holding spells : A review of literature with

11 additional cases. Amer. J. Dis. Child.,

91 : 23, 1956.

4. KA~NFR, L.–child psychiatry. Thomas,

Springfield. P. 393, 1957.

5. SCllARPEY-SCHAFER, E. P., HOWARD, P.,

LEATHART, G. L., and DORNHURST, A. C . – –

The faint ing lark and the mess trick.

Brit. Reed. J. 2 : 382, 1951.

6. VULLIAMY, D. G.–breath-holding attacks.

Practitioner. 177 : 517. 1996.