Botulinum Toxin Evaluated for Sialorrhea in Neonates

The retrospective review included 6 pediatric patients younger than 12 months of age in the neonatal intensive care unit.

The following article features coverage from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) Annual Meeting. Click here to read more of MPR‘s conference coverage.

Botulinum toxin (BoNT) injection appears to be a safe and effective noninvasive therapeutic alternative for the treatment of sialorrhea in neonates, according to findings presented at the AAO-HNSF 2021 Annual Meeting.

While BoNT is frequently used to manage sialorrhea in the general population, there is limited evidence surrounding its use in neonates. “We aim to discuss our experience and safety of BoNT use in the neonate population in regard to alleviating secretion management and airway protection,” the authors explained.

The retrospective review included 6 pediatric patients younger than 12 months of age in the neonatal intensive care unit (NICU) who received BoNT injection to submandibular (SMG) and parotid (PG) glands for the management sialorrhea and dysphagia. Of the total children, 2 were male, 2 had undergone surgical airway intervention previously, and all required feed tubes.

The average NICU stay was reported to be 87.5 ± 33.1 days. At initial BoNT injection, the average age was 1.5 ± 0.7 months and the average weight was 4.0 ± 1.1 kg. In 5 of the 6 cases, each PG and SMG was injected. The injected dose ranged from 5 to 15 Units per gland.

The study authors reported that 83% of patients were completely nil per os prior to injection; no clinical improvement in oral skills was noted post injection. Findings also revealed that 83% of patients reported a decrease in acute airway events post injection.

“Half (50%) had reported a decrease in O2 requirements and frequent suctioning 2 weeks after injection; however, 2 (33%) required surgical airway intervention after injection (trach, supraglottoplasty/mandibular distraction osteogenesis),” the authors added.

Findings of the analysis also revealed that 67% (4/6) of the patients were administered pharmacologic therapy; anticholinergics were reported to be the most commonly used.

A second injection was administered to half of the patients (age, 6.5 ± 0.3 months) 4.7 ± 0.7 months following the first injection. These same patients received a third injection (age, 12.5 ± 2.4 months) 6.1 ± 2.5 months following the second injection. One child received 6 injections in total. No injection-related complications were reported.

“BoNT injection is a safe, noninvasive alternative for management of sialorrhea in neonates,” the study authors concluded. They added, “Further extensive study needs to be performed to identify the optimal dose per gland in this population.”


Haykal NH, McCoy JL, Tobey A. Use of Botox for sialorrhea and dysphagia in neonates. Presented at: AAO-HNSF 2021 Annual Meeting; October 3-6, 2021; Los Angeles, CA.