ASSOCIATION BETWEEN IRON DEFICIENCY ANEMIA AND BREATH HOLDING SPELLS IN CHILDREN

Abstract

Objective: To determine the association between iron deficiency anemia and breath-holding spells in children aged 6 months to 60 months.

Methods: A case-control study was conducted at the Department of Pediatric Medicine, Ghulam Muhammad Mahar Medical College (GMC), Sukkur, over six months from 1 st September 2024 to 28 th February 2025. Non-probability convenience sampling was used to select 122 children aged 6 to 60 months, equally divided into cases and controls. The case group included children with breath-holding spells ≤ 60 seconds, while the control group comprised healthy children with no history of such spells. Detailed history, physical examination, and anthropometric measurements (weight and height) were recorded. Blood samples of 5cc were drawn for complete blood counts (CBC) and serum ferritin levels.  Exclusion criteria included children with febrile/non-febrile seizures, congenital heart disease, malnutrition, anticonvulsant therapy, or mental disabilities. The association between breath-holding spells and iron deficiency anemia was analyzed using a 2x2 table, and odds ratios (OR) were calculated. A p-value of ≤ 0.05 was considered significant.

Results: A total of 118 children, equally divided into case and control groups, were enrolled in the study. Cases were children aged 6-60 months with breath- holding spells lasting less than 60 seconds, identified through medical history and clinical evaluations. Controls were healthy children of the same age group with no history of breath-holding spells. The case group had 27 (46%) participants with iron deficiency anemia (IDA), while the control group had 16 (27%) with IDA, showing a significant association (OR: 2.268, 95% CI: 1.051-4.894). Mean ferritin levels were significantly lower in the case group (49.69 ± 22.67 ng/ml) compared to the control group (98.47 ± 21.98 ng/ml), and the case group had a higher mean corpuscular volume (35.80 ± 36.11 fl) compared to the control group (1.36 ± 0.55 fl). Among males, 55% of cases had IDA, compared to 30% in controls (OR: 2.909, 95% CI: 1.053-8.036). Urban children with breath- holding spells had a significantly higher likelihood of IDA (OR: 6.125, 95% CI: 1.330-28.207). No significant association was found between parental educational status and IDA.

Conclusion: Children with breath-holding spells, especially males and those from urban areas, are more likely to have iron deficiency anemia. These findings highlight the need for early screening for iron deficiency in children with breath holding spells, as addressing it may help reduce neurodevelopmental and behavioral issues. Further research, particularly longitudinal studies, is needed to explore the causal mechanisms and develop effective interventions for managing iron deficiency anemia in young children.