Evaluation and Management of Syncope in Pediatrics: A prospective Observational study at Sohag University Hospital

Background: Syncope is defined as temporary loss of consciousness and postural tone resulting from an abrupt transient decrease in cerebral blood flow. It is characterized by rapid onset, short duration and spontaneous complete recovery.
Objective: Our study aimed to analyze the frequency of syncope due to cardiac, neurocardiogenic, neurologic, situational, psychiatric, and other causes and make a differential diagnosis of syncope types according to detailed medical history and further investigations with focus on cardiac cause as the most serious type of syncope.
Patients and Methods: 125 pediatric patients were recruited from Arrhythmia Clinic in our Cardiology Unit, Sohag University Hospital. They presented with a primary complaint of syncope aged from 1year to 18 years with a mean age of 6.49 ± 3.77 years.
Results: The most common diagnosis was neurocardiogenic syncope (n=76, 60.8%). Sixty-four cases (84.2%) had recurrent episodes. Epilepsy was found in Thirty-four cases (27.2%) and psychogenic pseudo-syncope affected one female child. There were fourteen cases (11.2%) with cardiac syncope: 8 patients with LQTS, one patient with CPVT, one patient with AVNRT, 2 patients with dilated cardiomyopathy, 1 patients with history of atrioventricular (AV) canal defect closure and one patient with cardiac mass. There was significant relationship between arrhythmia and cardiac syncope (p < 0.001). Exercise-induced syncopes were significantly associated with cardiac origins (p < 0.001). Positive ECG, Holter and echocardiographic findings were statistically significant for cardiac syncope (P < 0.001).
Conclusion: Syncope is a common pediatric complaint. Most cases seen were resulting from benign causes, with only a small percentage because of serious medical conditions. In addition, most syncopal episodes in the pediatric population were diagnosed clinically or with minimally invasive testing, emphasizing the importance of a detailed history and physical examination.