Introduction

Breath holding spells are uncommon below 6 months of age. We describe 3 young infants with severe breath holding spells due to hypocalcemia and vitamin D deficiency.

Materials and methods

Three infants below 3 months of age were admitted to our hospital with severe cyanotic breath holding spells. All three underwent blood tests, echocardiography, electrocardiography, magnetic resonance imaging of the brain.

Results

Three infants aged 2, 4 and 5 ½ months (2 boys and 1 girl) were admitted with a history of severe cyanotic breath holding spells for under one week. All three had normal birth history and development prior to admission. All were exclusively breast fed. ECG, ECHO, MRI brain in all three were normal. Routine blood counts were normal. However serum calcium was 5.2, 4.6 and 5.6 mg/dl in the three patients respectively. Serum Vitamin D levels were 15, 5.8 and 7.4 ng/ml . Serum PTH levels were 376 and  676 pgm/ml ( normal 15-25 pg/ml) in two patients. All three children received intravenous calcium gluconate for three days with intra muscular vitamin D. Mothers were also detected to be vitamin D deficient and treated appropriately. On follow up after 1 month they had no further spells.

Conclusion

Hypocalcemia due to vitamin D deficiency is a treatable etiology of severe cyanotic breath holding spells in infants below 6 months of age. Maternal vitamin D deficiency may be responsible.