Research Article

Altered Neutrophil-to-Lymphocyte Ratio and Systemic Immune-Inflammation Index in Children with Breath-Holding Spells: A Retrospective Comparative Study

Volume: 6 Number: 2 August 31, 2026
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Altered Neutrophil-to-Lymphocyte Ratio and Systemic Immune-Inflammation Index in Children with Breath-Holding Spells: A Retrospective Comparative Study

Abstract

Objective: To evaluate whether complete blood count (CBC)-derived hematological and inflammatory indices differ between children with breath-holding spells (BHS) and a control group without neurological or chronic systemic disease, and whether laboratory parameters can contribute to distinguishing cyanotic and pallid subtypes. Materials and Methods: This retrospective, single-center comparative study included 47 children diagnosed with BHS (22 cyanotic, 25 pallid) and 50 controls without neurological, hematological, or chronic systemic disease. A complete blood count obtained at the diagnostic evaluation was available for 44 of the patients (21 cyanotic, 23 pallid) and for all 50 controls. CBC parameters, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were compared, and multivariable logistic regression was used to adjust the main comparisons for age and sex. Within the BHS cohort, iron status, vitamin B12, and thyroid function parameters were compared between the cyanotic and pallid subtypes. Results: Children with BHS had a significantly lower absolute neutrophil count (p=0.001, q=0.006), NLR (p<0.001, q<0.001), and SII (p<0.001, q<0.001), and a higher absolute lymphocyte count (p=0.004, q=0.019) than controls. Both NLR and SII remained associated with BHS after adjustment for age and sex (adjusted odds ratio 0.93 per 0.1 unit of NLR, 95% CI 0.89-0.98, p=0.006; 0.81 per 100 units of SII, 95% CI 0.70-0.94, p=0.005). ROC analysis showed NLR was the strongest single discriminator for BHS (AUC 0.765, 95% CI 0.663-0.866; Youden cut-off ≤0.661; 68.2% sensitivity, 82.0% specificity). No individual biochemical parameter differentiated the cyanotic and pallid subtypes (all p>0.05). Conclusion: Children with BHS showed a shift in neutrophil-lymphocyte balance that differs from the pattern usually seen in inflammatory conditions and is compatible with, although not proof of, autonomic dysregulation. Given their moderate discriminatory performance, NLR and SII are best regarded as supportive laboratory parameters that may accompany the clinical assessment of BHS.

Keywords

Supporting Institution

The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical Statement

This study was approved by the Institutional Ethics Committee. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Thanks

The authors have no acknowledgements to declare.

References

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Details

Primary Language

English

Subjects

Pediatric Neurology

Journal Section

Research Article

Publication Date

August 31, 2026

Submission Date

June 28, 2026

Acceptance Date

August 20, 2026

Published in Issue

Year 2026 Volume: 6 Number: 2

APA
Başarır, G., & Avcı, R. (2026). Altered Neutrophil-to-Lymphocyte Ratio and Systemic Immune-Inflammation Index in Children with Breath-Holding Spells: A Retrospective Comparative Study. Güncel Tıbbi Araştırmaları Dergisi, 6(2), 42-57. https://doi.org/10.52818/cjmr.1980864
AMA
1.Başarır G, Avcı R. Altered Neutrophil-to-Lymphocyte Ratio and Systemic Immune-Inflammation Index in Children with Breath-Holding Spells: A Retrospective Comparative Study. CJMR. 2026;6(2):42-57. doi:10.52818/cjmr.1980864
Chicago
Başarır, Günce, and Rıdvan Avcı. 2026. “Altered Neutrophil-to-Lymphocyte Ratio and Systemic Immune-Inflammation Index in Children With Breath-Holding Spells: A Retrospective Comparative Study”. Güncel Tıbbi Araştırmaları Dergisi 6 (2): 42-57. https://doi.org/10.52818/cjmr.1980864.
EndNote
Başarır G, Avcı R (August 1, 2026) Altered Neutrophil-to-Lymphocyte Ratio and Systemic Immune-Inflammation Index in Children with Breath-Holding Spells: A Retrospective Comparative Study. Güncel Tıbbi Araştırmaları Dergisi 6 2 42–57.
IEEE
[1]G. Başarır and R. Avcı, “Altered Neutrophil-to-Lymphocyte Ratio and Systemic Immune-Inflammation Index in Children with Breath-Holding Spells: A Retrospective Comparative Study”, CJMR, vol. 6, no. 2, pp. 42–57, Aug. 2026, doi: 10.52818/cjmr.1980864.
ISNAD
Başarır, Günce - Avcı, Rıdvan. “Altered Neutrophil-to-Lymphocyte Ratio and Systemic Immune-Inflammation Index in Children With Breath-Holding Spells: A Retrospective Comparative Study”. Güncel Tıbbi Araştırmaları Dergisi 6/2 (August 1, 2026): 42-57. https://doi.org/10.52818/cjmr.1980864.
JAMA
1.Başarır G, Avcı R. Altered Neutrophil-to-Lymphocyte Ratio and Systemic Immune-Inflammation Index in Children with Breath-Holding Spells: A Retrospective Comparative Study. CJMR. 2026;6:42–57.
MLA
Başarır, Günce, and Rıdvan Avcı. “Altered Neutrophil-to-Lymphocyte Ratio and Systemic Immune-Inflammation Index in Children With Breath-Holding Spells: A Retrospective Comparative Study”. Güncel Tıbbi Araştırmaları Dergisi, vol. 6, no. 2, Aug. 2026, pp. 42-57, doi:10.52818/cjmr.1980864.
Vancouver
1.Günce Başarır, Rıdvan Avcı. Altered Neutrophil-to-Lymphocyte Ratio and Systemic Immune-Inflammation Index in Children with Breath-Holding Spells: A Retrospective Comparative Study. CJMR. 2026 Aug. 1;6(2):42-57. doi:10.52818/cjmr.1980864