Infant botulism is a paralytic illness caused by the consumption of bacterial spores, found in honey, dust, dirt and the air. These spores, produced by the bacterium clostridium botulinum, will grow inside an infant's intestines where they will release the nerve toxin botulinum. Botulinum toxin blocks an infant's nerves from communicating with the muscles, rendering the muscles unable contract. Infants infected with botulism usually require a lengthy hospital stay in an intensive care setting, as these children often require mechanical ventilation. Although infant botulism can take up to five weeks to resolve, most patients recover completely. The treatment of infant botulism focuses primarily on airway management and proper nutrition.
Botulism Immune Globulin Intravenous
Botulism Immune Globulin Intravenous, also known as BIG-IV or BabyBIG, is a human-derived botulism antitoxin used in the United States to treat infant botulism. According to the Infant Botulism Treatment and Prevention Program, infants treated with BabyBIG have an average hospital stay of 2.3 weeks, while those who don't receive the drug average stays of up to 5.7 weeks. Infants receiving BabyBIG also recover their strength, tone and ability to move quicker than those who don't receive the drug. BabyBIG is given intravenously and is available from the California Department of Public Health.
Respiratory Management
As a paralytic illness, untreated infant botulism can progress quickly causing descending paralysis, which can affect an infant's airway and respiratory muscles. In addition, infants may also have a decreased gag reflex and difficulty swallowing. Because of this, airway and respiratory management are crucial. Infants with botulism will be continually monitored for signs of respiratory deterioration. Infants showing symptoms of respiratory distress will be intubated and placed on a ventilator until their condition improves and they can breath on their own. According to the Infant Botulism Treatment and Prevention Program, elevating an infant's upper body by 30 degrees and placing a small cloth roll behind the neck may prevent the need for mechanical ventilation in infant's with mild cases of botulism.
Nutritional Support
Due to the descending paralysis associated with infant botulism, most affected infants will not be able to tolerate oral feeds. Nutritional support for these infants will include either intravenous feeds through an IV line, enteral feeds through a feeding tube or a combination of both. Proper nutrition is important as it aids in healing. In addition, enteral feedings are known to help relieve constipation, a frequent symptom of infant botulism. Infants excrete botulism toxin and spores in their stools, so a return to proper bowel function can help infants recover faster. According to the American Academy of Family Physicians, most infants with botulism will be able to feed normally again approximately 50 days after admission to the hospital.
References
- Centers for Disease Control and Prevention: Botulism
- Infant Botulism Treatment and Prevention Program: Patient Management
- American Academy of Family Physicians: Infant Botulism
- KidsHealth from Nemours: Infant Botulism
- Infant Botulism Treatment and Prevention Program: Frequently Asked Questions about Infant Botulism
