Vagally Mediated BHS Info

A statement from the Southwest SIDS Institute:
"Breathholding spells (BHS) are quite common in the pediatric population, occurring 20% of normal infants and children. Most of these spells are harmless and need not treatment. However, vagally mediated BHS which occur in approximately 1 out of every 100 infants and young children are associated with increased morbidity and mortality. Sudden asystole or severe bradycardia (slowing of the heart), seizure activity, and even death may occur. Although many pediatricians consider all BHS to be behaviorally induced and tell the parents to ignore them, the Institute is receiving an increasing number of referrals from physicians and parents who recognize the serious, potentially lethal, nature of this problem. As a result, the board voted to support the establishment of what is believed to be the nation's first Breathholding Center, designed to provide evaluation and treatment of vagally mediated bhs in infants and children, nationwide. Project funds would be used to establish this center of excellence, evaluate and treat affected patients on a sliding scale basis, and assess the efficacy of various treatment modalities within the target population. Your support of this project would greatly improve the quality of life for these infants, young children and families."

Also, the Southwest SIDS Research Center is a participant in United Way of America. The annual United Way Pledge Drive is upon us. I would like you to please consider designating on your pledge forms Southwest SIDS as your donor designation of choice. By doing so you will actually know where your yearly contribution is going, how it is being utilized and could potentially be saving other children and families the anguish and grief of having a child that is ill and going untreated or worse yet, death. If this is something you think you would like to do, on your pledge forms please indicate you want your donation to go to:

Southwest SIDS Research and Treatment Institute
United Way # 46445-F, Brazos County United Way
In parenthesis you can put (Breathholding Center) to ensure the dollars get allocated properly.

This is the abstract of an article by Dr Dorothy Kelly:

EVALUATION AND TREATMENT OF VAGALLY MEDIATED BREATH-HOLDING SPELLS (BHS)

D.Kelly, J Henslee Southwest SIDS Research Institute, Lake Jackson, Tx

Breath-holding spells are common in infants and children. The more common type of BHS appears to be behaviorally induced. The more severe type occurs infrequently and is probably is under the control of the autonomic nervous system. It is the purpose of this study to describe the typical vagally induced BHS as well as several treatment modalities.

METHODS: We reviewed the charts of patients referred for evaluation and treatment of BHS. After obtaining informed consent, we spoke with the parents to obtain current as well as past medical history and family history.

RESULTS: There were 28 patients (13 males and 15 females) with a GA of 37.8 +/- 3.9 weeks, and birth weight of 3.23 +/- 0.80 kg. Average at onset was 13.2 +/- 13.7 months and at the time of referral for BHS was 15.6 +/- 12.1months. Pregnancy, labor, delivery, and nursery course was normal in most infants. 16 infants (57.1%) were referred initially for diagnosis and treatment of apnea. The most common characteristics of a BHS included: pain at onset, 1-2 strange cries followed by apnea, eyes open, then rolled, mouth open, tone stiff, and finally loss of consciousness. Vigorous stimulation usually resolved the BHS but CPR was used in 7 infants (25%). Typically the BHS end with a gasp, return to consciousness and an inconsolable cry followed by lethargy or sleep for up to 4 hours. Metaclopromide successfully controlled BHS in 40.9%, Donnatol in 36.4% and a combination of the two in 22.7%. Tegetrol was added in 9.1%. Average duration of follow-up 17.7 +/- 17.3 months. 25% of affected infants had a sibling and/or parent with a history of severe BHS. 45.8% had a family history of severe BHS in a sibling, parent, aunt, uncle or grandparent.

CONCLUSION: Vagally induced BHS are uncommon but do have characteristics, which should separate them from behaviorally induced BHS. They are usually controlled with metaclopromide and/or Donnatol, and occasionally with the addition of Tegretol.

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