Neonatal Botulism: A Case Series Suggesting Varied Presentations

David E Horvat¹, Philip G Eye², Mathew T Whitehead³, Diana Bharucha-Goebel⁴, Emmeline Roth⁵, Tayyba Anwar⁶, Tammy Tsuchida⁶, Youssef A Kousa⁷

Affiliations

¹ Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland.
² Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii.
³ Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
⁴ Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disroders and Stroke, National Institutes of Health, Bethesda, Maryland; Division of Neurology, Children's National Hospital, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
⁵ Division of Neurology, Children's National Hospital, Washington, District of Columbia; Neonatal Neurology Program, Children's National Hospital, Washington, District of Columbia.
⁶ Division of Neurology, Children's National Hospital, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Neonatal Neurology Program, Children's National Hospital, Washington, District of Columbia; Division of Neurophysiology, Epilepsy, and Critical Care, Children's National Hospital, Washington, District of Columbia; Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
⁷ Division of Neurology, Children's National Hospital, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Neonatal Neurology Program, Children's National Hospital, Washington, District of Columbia; Division of Neurophysiology, Epilepsy, and Critical Care, Children's National Hospital, Washington, District of Columbia; Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia. Electronic address: ykousa@childrensnational.org.

PMID: 37429225
PMCID: PMC10527512
DOI: 10.1016/j.pediatrneurol.2023.06.004

Neonatal Botulism: A Case Series Suggesting Varied Presentations

David E Horvat et al. Pediatr Neurol. 2023 Sep.

. 2023 Sep:146:40-43.

doi: 10.1016/j.pediatrneurol.2023.06.004. Epub 2023 Jun 14.

Authors

David E Horvat¹, Philip G Eye², Mathew T Whitehead³, Diana Bharucha-Goebel⁴, Emmeline Roth⁵, Tayyba Anwar⁶, Tammy Tsuchida⁶, Youssef A Kousa⁷

Affiliations

¹ Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland.
² Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii.
³ Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
⁴ Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disroders and Stroke, National Institutes of Health, Bethesda, Maryland; Division of Neurology, Children's National Hospital, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
⁵ Division of Neurology, Children's National Hospital, Washington, District of Columbia; Neonatal Neurology Program, Children's National Hospital, Washington, District of Columbia.
⁶ Division of Neurology, Children's National Hospital, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Neonatal Neurology Program, Children's National Hospital, Washington, District of Columbia; Division of Neurophysiology, Epilepsy, and Critical Care, Children's National Hospital, Washington, District of Columbia; Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
⁷ Division of Neurology, Children's National Hospital, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Neonatal Neurology Program, Children's National Hospital, Washington, District of Columbia; Division of Neurophysiology, Epilepsy, and Critical Care, Children's National Hospital, Washington, District of Columbia; Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia. Electronic address: ykousa@childrensnational.org.

PMID: 37429225
PMCID: PMC10527512
DOI: 10.1016/j.pediatrneurol.2023.06.004

Abstract

Infantile botulism is an uncommon diagnosis and rarer still in the neonatal period. We describe three cases of neonatal-onset botulism that presented with symptoms typically (hypotonia, constipation, facial diplegia) or atypically seen in older infants (encephalopathy, seizures, and hypothermia). Our series shows a wider spectrum of clinical presentations in patients with neonatal-onset botulism. Our report also suggests that neonatal-onset botulism should be considered more broadly in the hypotonic infant, especially as the condition is treatable with intravenous botulinum-specific immune globulin.

Keywords: Botulinum toxin; Botulism; Neonatal; Neuromuscular; Respiratory distress.

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Conflict of interest statement

Declaration of Competing Interest The authors declare no potential conflicts of interest with respect to the authorship and/or publication of this article.

Figures

**Figure 1.**
Repetitive nerve stimulation results for Case 2. A. Repetitive nerve stimulation at 2Hz left median nerve demonstrating 36.9% electrodecrement. B. High frequency repetitive nerve stimulation (20Hz) across left median nerve demonstrating 42% incremental response.

See this image and copyright information in PMC

References

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Neonatal Botulism: A Case Series Suggesting Varied Presentations

Affiliations

Neonatal Botulism: A Case Series Suggesting Varied Presentations

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical