129 - Social Demographic Factors Associated with Infantile Botulism

Publication Number: 129.6706

Timothy T. Phamduy, Dayton Children's Hospital, Dayton, OH, United States; Aleeya Shareef, Dayton Children’s Hospital, Dayton, OH, United States; Mellissa Mahabee, Dayton Children's Hospital, Dayton, OH, United States; Ramzi W. Nahhas, Wright State University Boonshoft School of Medicine, Dayton, OH, United States

Background: Although rare, infantile botulism, caused by Clostridium botulinum, is the most common form of human botulism in the United States. The incidence in children is greatest among the ages of one to six months. Early recognition and intervention can prevent morbidity and mortality associated with this neuroparalytic illness. Few studies have been performed recently examining outcomes and racial disparities in infantile botulism.

Objective: To estimate the magnitude of racial disparities in Intensive Care Unit (ICU) admission and hospital length of stay (LOS) for children aged 0 to < 1 year with a principal diagnosis of botulism.

Design/Methods: This study analyzed hospital discharge records from the Pediatric Health Information System between 1/1/2016 to 9/2/2024. Inclusion criteria were: a principal diagnosis of botulism food poisoning or infant botulism; complete information for age < 1 year gender, race/ethnicity, geographic region of admission, hospital LOS, and need for ICU admission. Logistic regression compared the odds of ICU admission between race/ethnicity groups, adjusted for age, gender, and geographic region. Negative binomial regression compared mean LOS between race/ethnicity groups, adjusted for age, gender, geographic region, intubation, oxygen therapy, and administration of BabyBIG.

Results: Of 619 patients, 50.2% were male, and 47.7% were from 3 to < 6 months old. BabyBig was administered to 90.5% of patients. Overall, race/ethnicity was not significantly associated with ICU admission (p = .057). However, non-Hispanic Black infants had 67% lower odds of admission to the ICU than non-Hispanic White infants (adjusted odds ratio (AOR) = 0.33; 95% CI = 0.15, 0.76; p = .007). Older age (p = .029) and geographic region (p < .001) were significantly associated with ICU admission. Infants in the West region had 70% lower odds of admission to the ICU than infants in the Northeast (AOR = 0.30; 95% CI = 0.17, 0.52; p < .001). Race/ethnicity was not significantly associated with LOS (p = .551). Age, geographic region, intubation, and oxygen support (p <.001 each) were all associated with LOS.

Conclusion(s): Advances in medicine have positively impacted early identification and outcomes of infant botulism. What is poorly understood and needs further investigation is the lower incidence of non-Hispanic Black infants admitted to the ICU. Possible causes include provider bias, racial biases against pain and severity of illness, lack of workforce diversity, and language barriers. Future studies are needed to characterize and mitigate racial disparities and reduce morbidity associated with infantile botulism.

Table. Patient Characteristics By Intensive Care Unit Admission
Patient demographic and outcomes data for pediatric botulism hospitalizations in the United States from 2016 to 2024.
1* n (%); Median (IQR); Mean (SD)


Figure 1. Forrest Plot for Intensive Care Unit Admission
ForestPlot_ICU_.jpegLogistic regression results evaluating associations between intensive care unit admission and race/ethnicity groups, adjusted for age, gender, and geographic region. NH = non-Hispanic, AOR = adjusted odds ratio, CI = confidence interval

Figure 2. Forrest Plot for Length of Stay
ForestPlot_LOS_.jpegNegative binomial regression results evaluating associations between mean length of stay and race/ethnicity groups, adjusted for age, gender, geographic region, intubation, oxygen therapy, and administration of BabyBIG. NH = non-Hispanic, IRR = incidence rate ratio, CI = confidence interval