Published online November 30, 2007
PEDIATRICS Vol. 120 No. 6 December 2007, pp. e1380-e1385 (doi:10.1542/peds.2006-3276)
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ARTICLE

Infant Botulism: A 30-Year Experience Spanning the Introduction of Botulism Immune Globulin Intravenous in the Intensive Care Unit at Childrens Hospital Los Angeles

Karen Underwood, MD, Sarah Rubin, MD, Timothy Deakers, MD, PhD and Christopher Newth, MB

Division of Critical Care, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California

OBJECTIVE. To report a tertiary care hospital's 30-year experience with the diagnosis, treatment, and outcome of infant botulism in the PICU before and after the availability of Botulism Immune Globulin Intravenous.

METHODS. This was a retrospective medical chart review of the 67 patients who had received a diagnosis of infant botulism and were admitted to the ICU from 1976 to 2005. The ages on presentation, length of hospital stay, length of ICU stay, length of mechanical ventilation, and type of botulism toxin were recorded and compared for patients who had received Botulism Immune Globulin Intravenous and those who had not. On the basis of our results, conclusions were drawn regarding the effect of Botulism Immune Globulin Intravenous on the morbidity of infant botulism.

RESULTS. Sixty-seven patients’ charts were reviewed; 23 male and 29 female patients did not receive Botulism Immune Globulin Intravenous. Of patients who did not receive Botulism Immune Globulin Intravenous, the median age at presentation was 71 days, median length of hospital stay was 35 days, ICU stay was 24 days, and duration of mechanical ventilation was 17 days. A total of 40% had type A toxin, and 60% had type B toxin. There was a significant difference between patients with toxin types A and B in length of hospital stay but not length of ICU stay or mechanical ventilation. Patients with type A toxin were significantly older than patients with type B toxin. Fifteen children received Botulism Immune Globulin Intravenous. There were statistically significant differences in length of hospital stay, length of ICU stay, and length of mechanical ventilation between patients who received Botulism Immune Globulin Intravenous and those who did not.

CONCLUSIONS. The use of Botulism Immune Globulin Intravenous significantly decreased the length of ICU stay, length of mechanical ventilation, and overall hospital stay in children with infant botulism.

Key Words: infant botulism • botulism immune globulin-intravenous • California Department of Health Services

Abbreviations: BIG-IV—Botulism Immune Globulin Intravenous • LOS—length of hospital stay • LOICUS—length of ICU stay • LOMV—length of mechanical ventilation • IQR—interquartile range • CHOP—Children's Hospital of Philadelphia

Accepted May 16, 2007.




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