Iron Supplementation for the Treatment of Breath-Holding Spells: A Systematic Review and Meta-Analysis

The pathophysiology of vasovagal syncope: Novel insights

“…Low iron levels, with or without anemia, were repeatedly reported in BHS (Azab et al, 2015). A meta-analysis of iron supplementation to patients with BHS and iron deficiency showed that supplementation reduced the frequency of spells (Hecht et al, 2020). The authors stressed that the treatment effect depended on iron deficiency, not on anemia.…”

“…Whether other metabolic parameters, such as vitamin D or iron levels, will affect clinical practice remains to be seen. However, the subject of 'iron in BHS' provides cause for thought: although there was no strong reason to think that iron would be involved in BHS, characterized as BHS is by a paroxysmal response to external triggers in otherwise healthy infants, there is now a meta-analysis showing that iron supplementation decreases BHS attack frequency (Hecht et al, 2020).…”

Intravenous Ferric Carboxymaltose as Rescue Therapy in Severe Breath Holding Spells: A Case Report and Literature Review

“…Zehetner et al [6] reported that iron supplementation (at 5 mg/kg/day of elemental iron for 16 weeks) significantly reduced the frequency of spells in 87 children (odds ratio, 76.48; 95% confidence interval, 15.65 to 373.72; P< 0.0001). In a recent meta-analysis of observational studies, the use of iron supplementation in subjects with BHSs who were iron-deficient reduced the frequency of BHS episodes, with an estimated 84% of children experiencing a > 50% reduction in episodes [5]. In a Turkish study, the comparison of responses to iron therapy among patients with and without anemia revealed that both spell burden and spell duration decreased in both groups, although these results were not statistically significant.…”

“…Iron deficiency anemia (IDA) has been considered a risk factor for BHS in nearly 50% of children [1]. The effectiveness of oral iron supplementation in reducing the frequency and severity of breath-holding attacks is well-known [5,6]. Here, we describe the case of a 9-month-old girl who frequently experienced BHSs and received intravenous (IV) iron supplementation for her anoxic repetitive seizure attacks.…”

“…Iron supplementation has been reported to substantially reduce BHSs in many studies [5,6]. Zehetner et al [6] reported that iron supplementation (at 5 mg/kg/day of elemental iron for 16 weeks) significantly reduced the frequency of spells in 87 children (odds ratio, 76.48; 95% confidence interval, 15.65 to 373.72; P< 0.0001).…”