DOI: 10.38053/acmj.2010597 ISSN: 2718-0115

Iron status and vitamin B12 levels in children with breath-holding spells: a case-control study

Ece Gültekin, Didem Yayla Karakurt
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Aims: Breath-holding spells are common non-epileptic paroxysmal events in early childhood and have been associated with iron deficiency. This study compared hematological, iron-related, and vitamin parameters between children with breath-holding spells and healthy controls and evaluated the independent associations of ferritin and vitamin B12 levels with breath-holding spells.Methods: This single-center case-control study included 32 children with breath-holding spells and 32 age-comparable controls evaluated at Biruni University Hospital between January 2025 and June 2026. Demographic, clinical, hematological, iron-related, and vitamin parameters were recorded. Multivariable logistic regression was performed.Results: The groups were comparable in age, gender, and body weight. Family history of breath-holding spells was more frequent in the patient group. Children with breath-holding spells had significantly lower hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, serum iron, transferrin saturation, ferritin, and vitamin B12 levels and higher red cell distribution width and total iron-binding capacity. Iron deficiency, iron deficiency anemia, and vitamin B12 deficiency were also more frequent. Higher ferritin (adjusted OR per 5-ng/ml increase: 0.76, 95% CI: 0.60-0.96; p=0.022) and vitamin B12 levels (adjusted OR per 50-pg/ml increase: 0.81, 95% CI: 0.67-0.98; p=0.031) were independently associated with lower odds of breath-holding spells.Conclusion: Reduced iron stores and lower vitamin B12 levels were independently associated with breath-holding spells, suggesting that assessment of both may be clinically relevant.

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