Breath Holding Spells in a 3-Day-Old Neonate: An Unusual Early Presentation in a Family with a History of Breath Holding Spells

Abstract

Breath holding spells are common in childhood. They peak about 2 years of age and abate by 5 years of age; they are rare before 6 months of age. We report a case of cyanotic breath holding spells starting at the age of 3 days. There was a family history of breath holding spells including a three-year-old brother, patient's father, his sister, and the paternal great grandfather. Pharmacological intervention with iron replacement therapy and piracetam was not successful. We want to draw attention to the fact that breath holding spells should be included in the differential diagnosis of neonatal cyanotic spells. The course of these neonatal breath holding spells is thought to be “benign”, but nevertheless, severe breath holding spells can pose problems for parents and clinicians.

Key words

Breath Holding Spells - Cyanosis - Neonate

References

• 1 Breningstall G N. Breath-holding spells.  Pediatr Neurol. 1996;  14 91-97
• 2 Daoud A S, Batieha A, al-Sheyyab M, Abuekteish F, Hijazi S. Effectiveness of iron therapy on breath-holding spells.  J Pediatr. 1997;  130 547-550
• 3 DiMario F J, Sarfarazi M. Family pedigree analysis of children with severe breath-holding spells.  J Pediatr. 1997;  130 647-651
• 4 Donma M M. Clinical efficacy of piracetam in treatment of breath-holding spells.  Pediatr Neurol. 1998;  18 41-45
• 5 Laxdal T, Gomez M R, Reiher J. Cyanotic and pallid syncopal attacks in children (breath-holding spells).  Dev Med Child Neurol. 1969;  11 755-763
• 6 Livingston S. Breathholding spells in children. Differentiation from epileptic attacks.  JAMA. 1970;  212 2231-2235
• 7 Lombroso C T, Lerman P. Breathholding spells (cyanotic and pallid infantile syncope).  Pediatrics. 1967;  39 563-581
• 8 Mocan H. Yildiran A, Orhan F, Erduran E. Breath holding spells in 91 children and response to treatment with iron.  Arch Dis Child. 1991;  81 261-262
• 9 Nair P MC. Breath holding spells in a neonate.  Indian Pediatr. 1995;  32 1129-1130
• 10 Silbert P L, Gubbay S S. Familial cyanotic breath-holding spells.  J Paediatr Child Health. 1992;  28 254-256
• 11 Singh K. Breath holding spells in a very young infant.  Indian Pediatr. 1995;  32 500
• 12 Stephenson J B. Blue breath holding is benign.  Arch Dis Child. 1991;  66 255-257
• 13 Weldon B C, Krafcik J M. Breath-holding-like spells in an infant: an unusual presentation of lingual thyroglossal duct cyst.  J Pediatr Surg. 2000;  35 1381-1384