Botulinum Toxin as a Treatment for Feeding Difficulties in Young Children

• Published in: The Journal of pediatrics 2020-11, Vol.226, p.228-235
• Main Authors: Hirsch, Suzanna, Nurko, Samuel, Mitchell, Paul, Rosen, Rachel
• Format: Article
• Language: English
• Subjects: Botulinum Toxins - administration & dosage; Child, Preschool; Endoscopy; Enteral Nutrition; feeding disorder; Female; Gastric Emptying; gastroparesis; Gastroparesis - diagnosis; Gastroparesis - etiology; Gastroparesis - therapy; gastrostomy tube; Humans; Infant; Injections; intrapyloric botulinum injection; Intubation, Gastrointestinal; Male; Neurotoxins - administration & dosage; Pylorus; Retrospective Studies; Treatment Outcome; vomiting
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2020.06.063

To determine the effectiveness of intrapyloric botulinum toxin injection (IPBI) for treatment of feeding disorders and associated gastrointestinal symptoms in very young children. A single-center retrospective study of patients 2 months to 5 years old who received IPBI at Boston Children's Hospital from May 2007 to June 2019 was performed. Charts were reviewed for demographic data, comorbidities, symptoms leading to IPBI, oral and tube feeding data, symptom improvement after IPBI, and need for repeat injections. The primary outcome was symptom improvement at the first gastroenterology clinic visit following IPBI. Secondary outcomes included improvement in oral feeding, decreases in tube feeding, and need for repeat injections. The χ2 or Fisher exact tests and multivariate logistic regression were used to identify factors associated with symptomatic improvement. A total of 85 patients who received 118 injections were included in the final analysis; 57 patients (67%) had partial or complete improvement in symptoms after IPBI. Among the 55 patients with enteral tubes, there was an improvement in feeding, with more patients receiving at least some oral feeds after IPBI compared with before (26/55 vs 15/55; P = .004) and fewer patients receiving postpyloric feeds after IPBI compared with before (12/55 vs 21/55; P = .01). Twenty-six patients (31%) received repeat IPBI within 1 year, with only 6 patients receiving IPBI more than twice. IPBI is safe and effective in young children. Children with enteral tubes show improvement in oral feeding and reduction in need for postpyloric feeding after IPBI.