This article is more than 5 years old. Information may no longer be current.
Botulism immune globulin IV treatment beneficial
Early recognition the best defense against the disease in infants.
Click Here to Manage Email Alerts
When used for the treatment of infant botulism, botulism immune globulin intravenous decreased the length of stay in the intensive care unit, the need for mechanical ventilation and the overall hospital stay, according to new research.
About 110 cases of botulism are reported in the United States each year, according to the CDC. Infant botulism accounts for 72% of these reported cases.
Symptoms typically begin with constipation and cranial nerve palsies and later progress to a generalized weakness. If the symptoms persist, however, the infant could end up needing lengthy hospital stays or admission into the ICU and long-term airway management.
“It is important to recognize the pattern of weakness or paralysis as a descending phenomenon, and that constipation may often be the presenting symptom,” researcher Sarah Rubin, MD, a critical care fellow at Childrens Hospital Los Angeles, told Infectious Diseases in Children. “Early recognition is our best defense against this potentially lethal disease.”
Rubin and colleagues from Childrens Hospital Los Angeles conducted a 30-year retrospective review of experience with the diagnosis and treatment of infant botulism in the pediatric ICU before and after the introduction of this form of treatment.
Their results were published recently in Pediatrics.
Pre- and post-treatment
In their review, the researchers included the medical charts of 67 patients who had received a diagnosis of infant botulism and were admitted to the ICU between 1976 and 2005; 23 boys and 29 girls did not receive botulism immune globulin IV.
All of the patients were divided into four groups based on the date of their admission to the ICU. The infants’ median age at presentation was 71 days. Median length of hospital stay was 35 days, median ICU stay was 24 days, and median duration of mechanical ventilation was 17 days, according to the researchers.
Forty percent of the infants (n=21) were confirmed to have type A toxin, and 60% (n=31) had type B toxin.
The 15 infants who received botulism immune globulin IV treatment during the study were shown to have shorter hospital stays (15 days vs. 27 days; P=.013), fewer days in the ICU (nine days vs. 18 days; P=.03) and less time needing medical ventilation (six days vs. 15 days; P=.03) compared with infants who did not receive the treatment during the same period.
The researchers also found that infants admitted before 1990 and did not receive botulism immune globulin IV had longer hospital stays (36 days vs. 15 days; P=.0001) and longer lengths of stay in the ICU (27 days vs. nine days; P=.0001) than infants admitted after 1990 who received the treatment.
“Our study encourages physicians to treat infant botulism once the diagnosis is suspected and not to wait for confirmation labs, such as stool samples,” Rubin said. “Though early treatment may not prevent the need for intubation or ICU admission, it certainly decreases the length of hospital stay, length of ICU stay and length of mechanical ventilation.”
“This will not only improve the quality of life for patients diagnosed with infant botulism but will also increase the availability of hospital resources for other children and reduce investigative and management costs,” she said. – by Cara Dickinson
For more information:
- Underwood K, Rubin S, Deakers T, Newth C. Infant botulism: a 30-year experience spanning the introduction of botulism immune globulin intravenous in the intensive care unit at Childrens Hospital Los Angeles. Pediatrics. 2007;doi:10.1542/peds.2006-3276. Accessed Jan. 7, 2008.