Neonatal Botulism: A Case Series Suggesting Varied Presentations

David E. Horvat, Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland.
Philip G. Eye, Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii.
Mathew T. Whitehead, Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Diana Bharucha-Goebel, 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.
Emmeline Roth, Division of Neurology, Children's National Hospital, Washington, District of Columbia; Neonatal Neurology Program, Children's National Hospital, Washington, District of Columbia.
Tayyba Anwar, 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.
Tammy Tsuchida, 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.
Youssef A. Kousa, 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.

Document Type

Journal Article

Publication Date

9-1-2023

Journal

Pediatric neurology

Volume

146

DOI

10.1016/j.pediatrneurol.2023.06.004

Keywords

Botulinum toxin; Botulism; Neonatal; Neuromuscular; Respiratory distress

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.

Department

Pediatrics

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