SELECTED STUDIES
"Infantile Emotional Stress Syndrome"
By Dr. Hesham Kandil, MD
I am a paediatrician for more than 25 years, worked in Egyptian, Kuwaiti and Saudi Arabian hospitals. Through out my career, I had an observation which was not recorded before. It simply concerned with the degree of response to emotional stress among infants. Infants usually cry when facing scary situation; becoming in bad mood or suffers from disturbed sleep.
However, this story was different; Youssef was 9 months old male infant a result of 34 weeks pregnancy, to healthy parents. Mother had two episodes of threatened abortion and recurrent vaginal bleeding during pregnancy. Delivery was normal vaginal, and birth weight was 2.3 kg. Neonatal period passed uneventfully and he received all his vaccination at time. Physical and developmental mile stones were appropriate. Exclusive breast feeding was continued for six months, hence soft diet started. He was the only child to the family. Parents were second degree cousins. Father was highly educated and a factory manger and mother was university graduate and caring for her son since delivery. Parents used to have recurrent emotional conflicts, last one was really serious and in the presence of Youssef. Mother developed some bruises and cried a lot after. On the following day, Youssef was observed to have weakness on his left upper and lower limbs. A diagnosis of acute infantile hemiplegia was clinically obvious.
An urgent brain CT revealed cerebral infarction secondary to vascular thrombosis. Through laboratory investigations did not reveal any underlying etiology.( Hb 11.9g/dl – MCV 70 fl – MCH 22.8 pg – Platelet 389.000/cmm – WBC 15.5/cmm – PT 11.2 sec – PTT 32.0 sec – bleeding time 2.5 min - HbA 90.1% - HbA2 1.7% - Hb F 8.2% - Protein C 92% - Protein S 95% - Antithrombin III 0.33g/l – Factor V gene mutation: normal wild type – Prothrombin gene mutation: normal wild type – MTHFR gene: Heterozygous mutation – Homocysteine 6.8 umol/L – normal ECHO findings)
Fortunately patient recovery was marvelous and rehabilitation therapy stopped after 3 months. Youssef received supportive treatment in the form of B1, B6 and B12 in addition to low dose of aspirin (5mg/kg).
To make my self clear, first; I realize that investigations for hyper-coagulable disorders are still premature and cannot be totally excluded.
Second; it is beyond doubt that stress situations can trigger inborn metabolic and autoimmune diseases.
Third; most paediatricians are aware of various vegetative, habit, anxiety, mood and disruptive behavioural psychological disorders in children that may happen in response to emotional stress.
Yet could acute infantile hemiplegia, be considered a consequence to emotional stress too? i.e. emotional stress event per se could cause thrombotic cerebral infarction in normal 9 months old infants?
I am proposing new syndrome "Infantile Emotional Stress Syndrome"; to cover the hall spectrum of infant response to emotional stress and I am very anxious to share experience with other physicians.
Dr Hesham H Kandil, MBChB, MSc, MD Pediatric is a Consultant Pediatrician, Egyptian Ministry of Health and Population, National Programs of Early Detection of Diseases and Prevention of Disabilities among children. His research interests are in clinical genetics, hematology and inborn metabolic disorders. He is the author and co-author of 21 papers. He also practices at his private clinic in Alexandira, Egypt. His email is heshamhkandil@hotmail.com.
