What is the best way of weaning Pyridostigmine in a 4 weeks old infant with Neonatal Transient Myasthenia Gravis ? the patient is tolerating his po feed but whenever we try to taper down Pyridostigmine, he can not suck well, and desaturates ! and when do you consider start weaning?

P.S: pt is 3.8 kg on Pyridostigmine 5 mg po Q6 hrs, Atropine 0.02 mg/kg po q8hrs.

I have no personal experience but if I remember correctly symtoms can stay for up to 3 months after birth.

Since symtoms are due to the presence of maternal antibodies, one needs to await the spontaneous clearance of these.

I suggest you let the infant "grow out" of the dose, i.e. you do not adjust doses per kg as the infant grows, given that the infant is feeding well and is cardiorespiratory stable.

Please report back how long the infant was treated and at what doses, when you have the full picture.

Greetings!

Early this year we had twin with neonatal Myasthenia , both received mechanical ventilation for 8-1o weeks and they were weaned successfully from Pyridostigmine by the age of 14 week with good outcome. Unfortunately mum died with mystheic crisis.