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How did the doctors solve the mystery of the child who cried incessantly?

For people who have just had a baby, it can be difficult to identify what is causing the baby discomfort. For example, why does a child cry? He rubbed his eyes; is it tired He started licking his lips; is he hungry The list of possible culprits and vague symptoms made even more vague by constant parental sleep deprivation can sometimes be endless; But for one family in New England, the list quickly ended when their baby’s condition worsened.

According to Detailed report The New England Journal of Medicine reported that the parents of a healthy 8-week-old boy noticed that their baby was crying more and becoming more irritable. This was about a week before he was admitted to the pediatric intensive care unit (PICU) of Massachusetts General Hospital.

The baby’s grandmother, who took care of him most of the time, noticed that when the right side of the baby’s abdomen was touched, he cried more. The baby’s family took him to the pediatrician; But no problems were found in the examinations and the doctor concluded that the reason for these cries is probably the presence of abdominal gas.

Rapid deterioration of the baby’s condition

When the baby returned home from the doctor’s office, he started crying again, and this time his crying continued for hours until he fell asleep. After waking up, she started crying again and this time she cried for 8 hours in a row and as a result she became weaker. That night, the baby was restless, shaking his arms and legs frantically and could not sleep. The baby was so weak that he could not drink milk and his mother poured milk into his mouth. His parents called the pediatrician and the doctor told them to take the baby to the emergency room as soon as possible.

The baby continued to cry weakly and restlessly in the emergency room. The doctors performed some tests on him, such as blood tests, and the results of all of them seemed completely normal; Common respiratory infections test results were negative, and urine and kidney function tests were also normal. Doctors also performed abdominal and chest imaging for the baby and did not find any problems in the baby; Even the ultrasound of her abdomen was completely normal.

The doctors noticed the high blood pressure and fast heartbeat of the sick baby

During their examinations, the doctors noticed that the baby has high blood pressure and heart rate and has not defecated since two days ago. They finally decided to hospitalize the baby. Four hours after the baby went to the hospital, symptoms of lethargy appeared in him; While no problem was found in the magnetic ray imaging of the baby’s head. The baby’s lumbar puncture revealed signs of meningitis, and for that reason, the doctors started antibiotic treatment, assuming that this was the cause of the baby’s problems.

The baby started to lose his ability to breathe 6 hours after entering the hospital. His blood oxygen saturation level had dropped from 97% upon arrival at the hospital to 85%, and for this reason, after providing the necessary oxygen to the baby, he was transferred to the Pediatric Intensive Care Unit (PICU). The baby’s cry had become much weaker and he could hardly move his limbs. According to the condition of the baby, the doctors decided to perform endotracheal intubation and start breathing with the device.

The process of eliminating possibilities

Doctors worked hard to get the correct diagnosis and assumed that all the problems of the baby were related to a specific cause. Without any obvious leads, they explored all possible possibilities. One of these possibilities was invasive infection, which has a high prevalence among infants; But none of his tests showed any obvious signs of infection. In the next steps, the doctors examined all the baby’s organs from top to bottom and ruled out one possibility after another.

The medical team first sought to find the cause of the baby’s cries and then went to the cause of his muscular paralysis. Hypotonia or reduction of skeletal muscle tone in infants occurs due to conditions that affect the central nervous system (CNS) or peripheral nervous system (PNS); But there was no evidence for either possibility. In addition, the doctors did not find any evidence of CNS disease.

A process of elimination led doctors to botulism; That is, the condition that justified all the symptoms of the baby. Botulism is a neuromuscular junction disease that causes symptoms such as irritability, constipation, disorders such as high blood pressure, rapid heartbeat, weak crying, drooping eyelids, inadequate nutrition, lethargy, weakness, and breathing problems. This disease mostly affects children aged 2 to 26 weeks.

The mystery is finally solved

Honey is a known source of Clostridium botulinum spores

In further investigations, it was found that the baby had abdominal discomfort before this disease and the family soothed him with honey. Honey is a well-known source of Clostridium botulinum spores (C. botulinum), which produce botulinum toxin in the body and cause infant botulism. Relying on the strong possibility that the baby has botulism, the doctors immediately ordered BabyBIG. BabyBIG is the only anti-botulism antibody that has been approved by the US Food and Drug Administration.

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