Herein, we present a newborn female with congenital
vocal cord paralysis who required a
tracheostomy in the neonatal period. She also presented with feeding difficulties. She was later diagnosed with a clinical picture of
congenital myasthenia, associated with three variants of the
MUSK gene: the 27-month follow-up was described. In particular, the c.565C>T variant is novel and has never been described in the literature; it causes the insertion of a
premature stop codon (p.Arg189Ter) likely leading to a consequent formation of a truncated nonfunctioning
protein. We also systematically collected and summarized information on patients' characteristics of previous cases of
congenital myasthenia with neonatal onset reported in the literature to date, and we compared them to our case. The literature reported 155 neonatal cases before our case, from 1980 to March 2022. Of 156 neonates with CMS, nine (5.8%) had
vocal cord paralysis, whereas 111 (71.2%) had feeding difficulties. Ocular features were evident in 99 infants (63.5%), whereas facial-bulbar symptoms were found in 115 infants (73.7%). In one hundred sixteen infants (74.4%), limbs were involved. Respiratory problems were displayed by 97 infants (62.2%). The combination of
congenital stridor, particularly in the presence of an apparently idiopathic bilateral
vocal cord paralysis, and poor coordination between sucking and swallowing may indicate an underlying
congenital myasthenic syndrome (CMS). Therefore, we suggest testing infants with
vocal cord paralysis and feeding difficulties for
MUSK and related genes to avoid a late diagnosis of CMS and improve outcomes.