Born into Toxicity or Just Another Masquerade: A Rare Case of Neonatal Paraquat Exposure

This case report details a rare and severe instance of neonatal paraquat exposure following maternal ingestion of the herbicide late in pregnancy. A full-term male neonate was delivered at 37+4 weeks after the mother consumed two spoonfuls (approx. 30 mL) of paraquat approximately 24 h before delivery. The newborn presented with immediate respiratory distress, birth asphyxia, meconium aspiration syndrome, and persistent pulmonary hypertension unresponsive to standard therapies. Despite aggressive interventions—including advanced ventilation strategies, inhaled nitric oxide, surfactant therapy, and multiple pharmacological agents—the neonate’s condition deteriorated, complicated by ventilator-associated pneumonia, acute kidney injury, and refractory pulmonary hypertension. The case underscores the diagnostic and therapeutic challenges posed by paraquat toxicity in neonates, particularly given the overlap with common neonatal syndromes and the lack of specific biomarkers for fetal exposure. Literature review reveals that such cases are exceedingly rare and often underreported, especially in India, with outcomes largely dependent on the timing and amount of exposure, promptness of intervention, and severity of maternal toxicity. This report highlights the need for heightened clinical awareness, early diagnosis, and aggressive management, while advocating for preventive public health measures to reduce maternal poisoning and its devastating neonatal consequences.