Jain Rahul, Omanakuttan Divin, Singh Amitabh, Jajoo Mamta
Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi, India.
J Paediatr Child Health. 2017 Aug;53(8):749-753. doi: 10.1111/jpc.13556. Epub 2017 Jun 1.
The aim of this study was to analyse the effect of iron supplementation in children with breath holding spells, irrespective of their iron status and study the factors associated with the response.
This was a prospective interventional study. Study population comprised of patients aged 6-36 months, attending a paediatric outpatient department with recurrent episodes (more than three in last 4 weeks) of breath holding spells. Children with loss of consciousness or convulsive movements associated with breath holding spells were considered as severe. After baseline investigations, all enrolled patients were given elemental iron at the dose of 3 mg/kg/day as a single daily dose. Four weekly follow-ups were done until 3 months after initiation of the intervention. At 12 weeks, investigations were repeated and outcome assessed for remission or decrease in severity of breath holding episodes.
A total of 100 children with breath holding spells received iron supplementation. Almost 73% of children showed complete response, with another 23% showing greater than 50% reduction in frequency. Frequency of spells at diagnosis and intolerance to oral iron were significantly associated with poor response to iron supplementation. Other factors such as age at onset, age at presentation, severity of spells, anaemia and serum iron parameters had no significant association with the response. Of the 27 children without iron deficiency (serum ferritin ≥ 30 µg/L), 77.7% responded completely to iron supplementation, similar to the iron-deficient group.
Iron supplementation is effective in the management of breath holding spells. Non-anaemic and iron-replete children with breath holding spells also respond well to iron supplementation.
本研究旨在分析补铁对屏气发作儿童的影响，无论其铁状态如何，并研究与反应相关的因素。
这是一项前瞻性干预研究。研究人群包括年龄在6至36个月、因反复屏气发作（过去4周内超过3次）到儿科门诊就诊的患者。伴有意识丧失或与屏气发作相关的抽搐动作的儿童被视为严重病例。在进行基线检查后，所有入组患者均按每日3mg/kg的剂量给予元素铁，每日单次给药。在干预开始后直至3个月，每4周进行一次随访。在12周时，重复进行检查并评估屏气发作缓解或严重程度降低的结果。
共有100名屏气发作儿童接受了补铁治疗。近73%的儿童显示出完全反应，另有23%的儿童发作频率降低超过50%。诊断时的发作频率和对口服铁的不耐受与补铁治疗反应不佳显著相关。其他因素，如发病年龄、就诊年龄、发作严重程度、贫血和血清铁参数与反应无显著关联。在27名无缺铁（血清铁蛋白≥30μg/L）的儿童中，77.7%对补铁治疗完全反应，与缺铁组相似。
补铁对屏气发作的治疗有效。无贫血且铁充足的屏气发作儿童对补铁治疗也反应良好。
