Breath-holding Spells and Its Management Study

The number of wrongful and missed diagnoses (definition: managed and diagnosed as breath-holding spells at physician assessment within study but later found to be another cause for the symptoms, like long QT syndrome or epilepsy).

Assessed according to the following:

• Number of patients with a diagnostic interventions for each intervention in the guidelines: ECGs and bloodtests.
• Number of found pathologies for each intervention (blood tests and ECGs) - for patients with typical spells handled according to the guidelines and those with non-typical spells managed individually. This includes a retrospective assessment of ECG (a complete assessment including rythm, long QT syndrome, AV-block, ST-segment changes) and blood test results (for anemia and iron deficiency; i.e. values outside of the age adapted normal range).
• Retrospective analysis of the clinical doctors compliance with managment guidelines, evaluated through the number of interventions for each patient that were not recommended in the guidlines (for instance number of EEGs).

Assessed according to the following:

• Adherence to the the prespecified definition of typical spells through comparison of clinical physicians assessment and a retrospective assessment by study physician, i.e. the number of cases with a discrepant judgment of the clinical presentation.
• The number of typical spells compared to the number of non-typical spells and other diagnsoses.
• Compilation of patient and spell characteristics (defined in the variable list in the attached documents) and comparison with the current definition of typical spells.

Through interview study (qualitative study) gather information on given information and support and their need for more information and support. Will be conducted on parents of children with more than 5 spells in total at the 6 month follow up (assessed as frequent spells).

In cases of iron treatment (initiated by the clinical physician). Assessed according to the following:

• Comparison of spell frequency (number of spells/time unit) before start of treatment, during treatment and after completion of treament.
• Comparison of spell severity (simple or severe spells defined as spells without and with loss of consciousness) before start of treatment, during treatment and after completion of treament.
• Anemia and iron deficiency blood test values (Hb, MCV, reticulocytes, ferritin, CRP if signs of infection, iron, iron saturation and transferrin) comparison between patients with effect of iron treatment on spell frequency and severity, versus the group without a clinical effect of iron treatment.
• Patient compliance for iron supplementation as per survey question with answer altneratives yes/no/don't know

Assessed according to the following parameters, through digital surveys:

• Spells during the last 3 months (yes or no)
• Number of spells the previous month (0, 1, 2-5, 6-10, >10)
• Total number of spells (free text)
• Uncontactable or unconscious (=severity of spells) (Yes, No, Don't know)
• Alterations in spell semiology? (Yes, No, Don't know)

Evaluation of the following questions:

• Do parents follow the advice to reach out to health care if the spell semiology change?
• Planned follow up?

Above questions are assessed in a digital survey:

• Further contact with healthcare. Answer alternatives: (Yes, No, Don't know). If yes: (acute or planned)

Will be assessed through a combined evaluation of the following variables:

• Number of acute health care visits
• Number of planned health care visits including follow-up appointments over phone
• Number of over-night hospital stays (number of nights)
• Number of ambulance rides to the hospital

At first visit, parents will answer questions on the child and family's diet in a questionnaire, to evaluate a possible association between diet and iron status (and further, to breath-holding spell frequency and severity).

The questions are as follows:

• Mark all alternatives that is correct about your childs diet: (breatmilk/formula/cow's milk/taste portions/family meals)
• Does your child drink more than 3 dl of cow's milk per day? (yes/no)

> If yes, estimate the amount of cow's milk your child drink during a day in dl: (a number in free text)

• Do you eat vegetarian or vegan food only? (yes/no)