Airway complications of infant botulism: ten-year experience with 60 cases.
OBJECTIVE
The study goal was to understand the incidence, etiology, and management of airway complications in infant botulism.


METHODS
We conducted a retrospective review of the period from January 1, 1987, to December 31, 1997.


METHODS
Urban tertiary care children's hospital.


RESULTS
Of 60 children with infant botulism, 37 (61.7%) required endotracheal intubation for a mean of 21 days. No patient required a tracheostomy. Airway complications (stridor, subglottic stenosis, granuloma formation) occurred in 5 (13.5%) of 37 patients, with 3 requiring surgical bronchoscopy. Of the 37 children, 14 (37.8%), including 4 with airway complications, had endotracheal tube leak pressures recorded. In 3 (50%) of 6 patients with measured leak pressures of greater than 40 cm H2O, airway complications developed. Complications did not develop in patients with leak pressures of less than 20 cm H2O. No correlation between length of intubation and complications could be established.


CONCLUSIONS
Airway complications in infant botulism may be accompanied by high leak pressures and can be managed with endoscopic techniques. The study data suggest that leak pressures should be measured on a regular basis and maintained at less than 20 to 25 cm H2O. A prospective trial to study this issue is warranted. Tracheotomy is not routinely necessary. A high index of suspicion, early diagnosis, and prompt intervention are required for the optimal management of airway complications in infant botulism.
Anderson
Timothy D
TD
Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, University of Pennsylvania, 19104-4399, USA.
Shah
Udayan K
UK
Schreiner
Mark S
MS
Jacobs
Ian N
IN
D001906:Botulism / Q000150:complications* / Q000628:therapy; D003014:Clostridium botulinum; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies