Do not disregard or avoid professional medical advice due to content published within Cureus
Do not disregard or avoid professional medical advice due to content published within Cureus. The authors have declared that no competing interests exist. Human Ethics Consent was obtained or waived by all participants in this study. He was evaluated one month later and was doing well. A positive history of MG in the mother associated with a suggestive physical examination may be sufficient to make the diagnosis of transient neonatal MG, emphasizing the importance of good medical history. With prompt diagnosis and appropriate management, most newborns experience spontaneous remission after a period of weeks to months. strong class=”kwd-title” Keywords: neostigmine, immunoglobulin, anticholinesterase agents, hypotonia, transient neonatal myasthenia gravis Introduction Transient neonatal myasthenia gravis (TNMG) is an antibody-mediated disorder caused by the transplacental transmission of maternal antibodies directed against the acetylcholine receptor (AChR) and, less frequently, muscle-specific kinase (MuSK), resulting in impaired neuromuscular transmission [1,2]. It is a rare disease and may be present in 10%-15% of newborns born to women with myasthenia gravis, KU-0063794 either active or, less commonly, in remission [3-5]. The risk of recurrence in subsequent pregnancies is 75% [4,5]. TNMG mainly manifests with hypotonia and poor feeding that, in most cases, resolves spontaneously and progressively in the first two months of life. Respiratory muscles may be involved leading to respiratory distress and failure, requiring ventilatory support. It is a clinical diagnosis in which a suggestive clinical history and physical examination may be sufficient to confirm the diagnosis. Supportive treatment may be Rabbit polyclonal to KLF4 enough in mild cases, but severe cases require anticholinesterase agents. We report a case of a newborn with TNMG who needed feeding support and pharmacological treatment. Case presentation A 2990 g newborn male, the second child of non-consanguineous parents, was transferred to the neonatal intensive care unit (NICU) 38 hours after birth due to feeding difficulties and choking episodes. He was born to a 31-year-old G6P2A4 mother after an uneventful, well-followed pregnancy, in which the mother felt normal fetal movements. She was diagnosed with MG nine?years before and medicated KU-0063794 with pyridostigmine. Thymectomy was performed three years after the diagnosis due to a thymoma. She was asymptomatic during pregnancy. His nine-year-old sister was born just before the mothers diagnosis and had no symptoms during the neonatal period. She had three spontaneous abortions, and no investigation?was undertaken. An elective cesarian section, due to a previous cesarian section, was performed at 41 weeks of gestation. The delivery was uneventful, with Apgar scores of 9 and 10 at one?and five minutes, respectively. Two hours after birth, he developed intermittent grunting with apparent normal suction reflexes. At first, he was breastfed but rapidly demonstrated feeding difficulties due to poor sucking. Initial laboratory evaluation, including complete blood count, differential count, C-reactive protein, and kidney function, demonstrated normal results, except for elevated creatinine kinase?and elevated anti-AChR antibody concentration of 36.30 nmol/L (normal: 0.25 nmol/L). On admission to NICU, he revealed a weak cry, swallowing and sucking difficulties, weak facial mimic, and a constantly open mouth (Figure ?(Figure11). Figure 1 Open in a separate window Newborn with a persistently open mouth. KU-0063794 He assumed a frog leg position and showed generalized hypotonia with marked head lag (Figure ?(Figure22). Figure 2 Open in a separate window Generalized hypotonia with marked head lag. Ptosis was not present, but there was a persistent inability to fully close his eyelids. No respiratory distress was present. Moro reflex and grasp reflex were present. Due to feeding difficulties, he started gavage feeding. TNMG diagnosis was admitted, and on his fourth day of life, neostigmine was initiated under neuropediatric guidance at a dose of 0.04 mg/kg, six times a day, subcutaneously (SC). Since there was only a slight improvement.