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Abstract

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How Recent is the Evidence
  10. Research Gaps

This is a summary of a Cochrane review, published in this issue of EBCH, first published as: Zehetner AA, Orr N, Buckmaster A, Williams K, Wheeler DM. Iron supplementation for breath-holding attacks in children. Cochrane Database of Systematic Reviews 2010, Issue 5. Art. No.: CD008132. DOI: 10.1002/14651858.CD008132.pub2. Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration


Objectives

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How Recent is the Evidence
  10. Research Gaps
  • This review aims to assess the effect of iron supplementation on the frequency and severity of breath-holding attacks in children.

Relevance

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How Recent is the Evidence
  10. Research Gaps
  • Breath-holding attacks (BHA) are paroxysmal events affecting approximately 5% of healthy children.

  • Sympathetic nervous system activation may occur resulting in the child sweating and becoming pale, taking on an almost ‘deathly’ appearance (a pallid BHA) or becoming blue in the face and lips (a cyanotic BHA).

  • Severe BHA are defined as those attacks resulting in loss of consciousness with or without abnormal movements.

  • Children may have multiple episodes per week for 1–3 min. Attacks usually spontaneously cease without any medical treatment by 7 years of age, with most remitting between 3–4 years of age. BHA are most common in children aged 6 months to 6 years, with 76% of cases occurring between 6–18 months of age.

  • Anaemia has been suggested to exacerbate the likelihood of BHA because the lower haemoglobin results in more rapid cerebral anoxia.

  • Iron therapy is a relatively low-cost and freely available treatment that is believed to assist in reducing this condition without causing unacceptable adverse drug effects.

Results

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How Recent is the Evidence
  10. Research Gaps
  • Compared to placebo, two studies found that iron supplementation significantly decreased the frequency of BHA in children (OR: 76.48; 95% CI: 15.65, 373.72). Iron supplementation was also significantly more likely to eliminate BHA entirely (OR: 53.43; 95% CI: 6.57, 434.57).

  • In one study, 88% of children receiving iron showed either complete or partial resolution of symptoms, compared to 6% of children receiving placebo.

  • In the second study, 100% of children receiving iron showed either complete or partial symptom resolution, compared to 40% of children in the first control group and 60% of children in the second control group.

Implications

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How Recent is the Evidence
  10. Research Gaps
  • Iron supplementation appears to be useful in reducing the frequency and severity of BHA in children with iron deficiency anaemia.

  • It is not year clear whether iron is of assistance in children who are not anaemic or who have low but normal haemoglobin levels, because only studies with data presented together for both anaemic and non-anaemic children are currently available.

  • More evidence is needed in children without anaemia.

Research Gaps

  1. Top of page
  2. Abstract
  3. Objectives
  4. Relevance
  5. Participants
  6. Comparison
  7. Results
  8. Implications
  9. How Recent is the Evidence
  10. Research Gaps
  • Further high-quality randomized controlled trials of iron supplementation to treat BHA in children are required. In particular, studies in populations of children who are not iron-deficient, seen in non-tertiary settings, live in developed communities and receive oral iron supplementation as the sole intervention (in a standardized dose of 5 mg/kg/day of elemental iron) are needed. To ascertain the treatment effect of iron in further detail, trials involving longer follow-up and assessing the effect of iron cessation (after a positive response on BHA) should be conducted.