Katılma Nöbeti ile Başvuran Çocuklarda Vitamin D Düzeyleri: Bir Üniversite Hastanesi Örneği

Yıl 2023, , 758 - 763, 28.09.2023

Rojan İpek , Celal Varan

https://doi.org/10.31020/mutftd.1331209

Öz

Amaç: Bu çalışmanın amacı, katılma nöbetleri ile başvuran çocuklarda vitamin D düzeylerini araştırmak, bunları sağlıklı kontrol grubu ile karşılaştırmak ve nefes tutma nöbetleri ile vitamin D düzeyleri arasındaki ilişkiyi ortaya koymaktır.
Yöntem: Aralık 2019 ile Ekim 2022 tarihleri arasında Adıyaman Üniversitesi Eğitim ve Araştırma Hastanesi Çocuk Nöroloji ve Çocuk Kardiyoloji polikliniklerine başvuran 98 hastanın dosyaları retrospektif olarak incelendi. Dahil etme kriterlerini karşılamayan 52 hasta çalışma dışı bırakıldı. Kırk altı çocuk katılma nöbeti grubu, 53 sağlıklı çocuk kontrol grubu olarak çalışmaya dahil edilmiştir. Tüm hastalarda Fe, serum demir bağlama kapasitesi, ferritin, vitamin B12 ve vitamin D düzeyleri ölçüldü.
Bulgular: Çalışma grubu 27 kız (%58,6), 19 erkek (%41,3) olmak üzere 46 hastadan (K/E=1,4) oluşuyordu. Hasta grubumuzun 39’u (%84,8) siyanotik tip, 3’ü (%6,5) soluk tip ve 4’ü (%8,7) karışık tip katılma nöbeti tanısı almıştı. Katılma nöbetiyle başvuran hastaların özellikle tam kan sayımı, demir seviyeleri, demir bağlama kapasitesi, ferritin seviyeleri, vitamin B12 ve vitamin D seviyeleri gibi parametreler üzerinden kapsamlı bir analiz yapıldı. Bu çalışmada vitamin D seviyeleri ile anlamlı bir ilişki tespit edilmemiş olsa da düşük hemoglobin seviyeleri, azalmış B12 vitamini seviyeleri ve azalmış ferritin seviyeleri ile kayda değer bağlantılar kuruldu. Ayrıca B12 vitamini değerleri düşük olan hastaların analiz dışı bırakılmasıyla demir eksikliği anemisi ile katılma nöbetleri arasında istatistiksel olarak anlamlı bir ilişki ortaya çıktı (p<0,05).
Sonuç: Çalışma sonuçları, düşük D vitamini düzeyleri ile genellikle olumlu prognoza sahip olan BHS arasında anlamlı bir ilişki olmadığını göstermektedir. Bununla birlikte, demir eksikliği anemisi ve vitamin B12 seviyeleri arasındaki potansiyel bağlantılar göz önünde bulundurulduğunda, bu faktörlerin rutin olarak değerlendirilmesi tavsiye edilmektedir.

Anahtar Kelimeler

Katılma nöbeti, Çocuk, Vitamin D

Vitamin D Levels in Children Presenting with Breath-Holding Spells: An Example of A University Hospital

Öz

Aim: This study aimed to examine the vitamin D levels in children who experience breath-holding spells (BHS) and to compare these levels with those of a healthy control group. The goal was to establish a connection between BHS and vitamin D levels.
Method: The records of 98 patients, who presented to the Pediatric Neurology and Pediatric Cardiology polyclinics of Adıyaman University Training and Research Hospital between December 2019 and October 2022, were retrospectively reviewed. Fifty-two patients who did not meet the inclusion criteria were excluded. The study included forty-six patients with BHS whose laboratory results were assessed and a healthy control group of fifty-three individuals. Fe, serum iron binding capacity, ferritin, vitamin B12, and vitamin D levels were measured in all patients.
Results: The study group comprised 46 patients (female/male ratio = 1.4), consisting of 27 girls (58.6%) and 19 boys (41.3%). Within our patient cohort, 39 individuals (84.8%) were diagnosed with cyanotic-type spells, three (6.5%) with pallid-type spells, and four (8.7%) with mixed-type spells. For patients experiencing BHS, a comprehensive analysis was conducted on parameters including complete blood count, iron levels, iron-binding capacity, ferritin levels, vitamin B12, and vitamin D levels. Although no significant correlation was identified with vitamin D levels in this study, noteworthy connections were established with lower hemoglobin levels, decreased vitamin B12 levels, and reduced ferritin levels. Moreover, upon exclusion of patients exhibiting low vitamin B12 values from the analysis, a statistically significant relationship emerged between iron deficiency anemia and the occurrence of BHS (p<0.05).
Conclusion: The study results suggest no significant correlation between low vitamin D levels and BHS, which generally have a favorable prognosis. However, considering the potential connections between iron deficiency anemia and vitamin B2 levels, it is advisable to assess these factors routinely.

Anahtar Kelimeler

Breath-holding spell, Child, Vitamin D

Kaynakça

• 1. Lombrosso CT, Lerman P. Breathholding spells (cyanotic and pal¬lid infantile syncope). Pediatrics 1967;39:563-81.
• 2. Mocan H, et al. Breath holding spells in 91 children and response to treatment with iron. Arch Dis Child 1999;81(3):261–2.
• 3. Hamed SA, Gad EF, Sherif TK. Iron deficiency and cyanotic breath holding spells: The effectiveness of iron therapy. Pediatr Hematol Oncol 2018;35(3):186-95.
• 4. Breukels MA, et al. Breath holding spells in a 3 day old neonate: an unusual early presentation in a family with a history of breath holding spells. Neuropediatrics 2002;33:41-2.
• 5. Sim, JJ, et al. Vitamin D deficiency and anemia: a cross-sectional study. Annals of hematology 2010;89(5):447-52.
• 6. Subbarayan A, Ganesan B, Anbumani, jayanthini. Temperamental traits of breath holding children: A case control study. Indian J Psychiatry 2008;50:192-6.
• 7. Carman KB, et al. Breath holding spells: Point prevalence and associated factors among Turkish children. Pediatr Int 2013;55:328-31. 8. Leung AKC, et al. Breath-holding spells in pediatrics: a narrative review of the current evidence. Curr Pediatr Rev 2019;15:22-9. 9. Goraya JS, Verinderjit SV. Persistance of breath holding spells into late childhood. J Child Neurol 2001;16:697-8. 10. Işıkay S. Katılma Nöbeti Olan 180 Çocuk Hastanın Değerlendirilmesi. Turkiye Klinikleri J Pediatr 2014;23(2).
• 11. Laxdal T, Gomez MR, Reiher J. Cyanotic and pallid syncopal attacks in children (breath-holding spells). Dev Med Child Neurol 1969;11:755–63.
• 12. Aydın H, Bucak H, Erdoğan S. Vitamin B12 and Folic Acid Levels in Patients with Breath Holding Spells. Turkish J Pediatr Dis/Türkiye Çocuk Hast Derg 2023;17:113-7.
• 13. DiMario FJ. Breath holding spells in childhood. Curr Probl Pediatr 1999;29:281-300.
• 14. Goldman RD. Breath-holding spells in infants. Can Fam Physician 2015;61(2):149-50.
• 15. Yilmaz U, et al. The value of neurologic and cardiologic assessment in breath holding spells. Pak J Med Sci 2014;30(1):59–64.
• 16. Tomoum H, et al. Paediatric breath holding spells are associated with autonomic dysfunction and iron deficiency may play a role. Acta Paediatr 2018;107(4):653-7
• 17. Daoud AS, et al. Effectiveness of iron therapy on breath-holding spells. J Pediatr 1997;130:547. 18. Orri KE, Kato Z, Osamu F. Changes of autonomic nervous system function in patients with breath holding spells treated with iron. J Child Neurology 2002;17:337-40.
• 19. Ozcora GDK, et al. Evaluating the brainstem in children with breath-holding spells. North Clin Istanb 2022;28;9(6):610-5.
• 20. Arslan H, et al. The evaluation of physiological and biochemical parameters and the autonomic nervous systems of children with breath-holding spells. Neuropediatrics 2014;45(4):212-6.
• 21. Hesamifar M, Daryoushi H, Sedighi M. Evaluation of the Predictors of Breath Holding Spell (BHS) in under 5-Year-Old Children in Iran: A Hospital-Based Case-Control Study. International Journal of Pediatrics 2021;9(9):14382-92.
• 22. Duman İ, Ün İ. Sekosteroit hormon olarak D vitamini ve kanser ilişkisi. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi 2019;9(1):19-29.
• 23. Özkale Y, Erol İ, Özkale M. Serum Magnesium and Calcium Levels in Children with Breath-holding Spells. Erciyes Medical Journal/ Erciyes Tip Dergisi 2018;40(2):78-80.
• 24. Culpeper N. A Directory for Midwives: or a Guide for Women in Their Conception, Rearing and Suckling Their Children. Hitch and Hawes, London, 1762.
• 25. DiMario FJ, Sarfarazi M. Family pedigree analysis of children with severe breath-holding spells. J Pediatr 1997;130:647– 51.
• 26. Işikay S, Carman KB. Prevalence of breath holding spells among children in Gaziantep, Turkey. Journal of Pediatric Neurology 2014;12(03):137-9.
• 27. Gürbüz G, et al. Iron supplementation should be given in breath-holding spells regardless of anemia. Turkish Journal of Medical Sciences 2019;49(1):230-237.
• 28. İbili AB, Çavuşoğlu D. Is iron supplementation the only treatment choice for breath holding spells? Umraniye Pediatri Dergisi 2023;3(1):14-20