Baby Please Breathe!
An Unusual and Atypical Presentation of Breath-Holding Spells

Background: Breath-holdings spells (BHS) are frequent and benign in most children. The typical age group of presentation is between 6 months to 6 years. Medical therapy is not needed in most cases and the mainstay of treatment is reassurance of the parents. There is an association of anaemia and a positive family history of BHS in some cases. However, most cases have no known etiology and the underlying pathophysiology still remains controversial.

Results: We present a neonate who had recurrent episodes of cyanosis during day 1 of life who was eventually diagnosed with BHS. In view of the young age, other concerns of seizures and long QT syndrome were important to rule out. A normal neuro-imaging, electroencephalogram with electrocardiogram were reassuring. Subsequently the child was discharged and noted to have normal neuro-development. Parents had home-video recordings of these recurrent episodes which appeared to happen after periods of stress or agitation to the child thus making BHS a likely diagnosis.

Conclusion: BHS can be frustrating to both parents and physicians alike in view of the relative lack of control we have other such episodes with no consensus on any particular drug therapy. This condition causes significant caregiver stress and is over-investigated in most cases. This case demonstrates the need to include BHS as one of the differential diagnosis of neonatal cyanosis spells.