Affiliations: [a] Gillette Children’s Specialty Healthcare, St.Paul, MN, USA
| [b]
University of Minnesota, St. Paul, MN, USA
Correspondence:
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Corresponding author: Supreet Deshpande, Gillette Children’s Specialty Healthcare, 200 University Ave E, St. Paul, MN, 55101, USA. Tel.: +1 6512293819; Fax: +1 6512657443; E-mail: [email protected].
Note: [] What is known: There have been many studies showing the safety of botulinum toxin in children older than two years, but there are very few looking at the safety of botulinum toxin injections in children less than one year of age.
Note: [] What is new: Charts of 47 patients who received botulinum toxins were evaluated and assessed for safety in this study. Children less than one year and 13 days of age tolerated botulinum toxin injections with very few adverse events.
Abstract: PURPOSE:Infants can have muscle hypertonia due to cerebral palsy, muscle strength imbalances due to brachial plexus palsy, refractory clubfoot, and torticollis. These muscle problems can cause significant development impairments. A child with severe sialorrhea and dysphagia from leukodystrophy can aspirate, causing respiratory problems. Botulinum toxin (BoNT) injections can improve these conditions but may lead to adverse effects from the toxin spreading to non-targeted muscles, potentially impacting breathing, swallowing, and overall strength. This is particularly concerning in infants. This study assessed the safety of BoNT injections in children less than one year of age. METHODS:This was a retrospective cohort study. RESULTS:Forty-seven patients (22 male, 25 female) received BoNT injections before one year of age (three to 12 months). Thirty-seven received one round of injections and 10 were injected on multiple occasions. Forty-five received onabotulinumtoxinA (15–100 units [U], 1.9–15.2 U/kg), one received abobotulinumtoxinA (70 U, 9.0 U/kg), and one received incobotulinumtoxinA (25 U, 3.5 U/kg). Lower extremities were treated in 15 patients, upper extremities in 38, the sternocleidomastoid in two, and the salivary glands in one. Forty-five patients had no reported complications. One experienced transient fever, vomiting, and diarrhea. The parent of another reported subjective weakness in one muscle. CONCLUSION:BoNT injections in children less than one year of age appear to be safe.
