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Journal of Tropical Pediatrics 1981 27(6):308-311; doi:10.1093/tropej/27.6.308
© 1981 by Oxford University Press
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Tetanus Neonatorum

(A Preliminary Report of Assessment of Different Therapeutic Regimens)

SULEMAN DAUD, M.B.B.S., Dr. TUFAIL MOHAMMAD, D.C.H., M.C.P.S. and Dr. ASHFAQ AHMAD, D.C.H., F.R.C.P., F.A.A.P., F.C.P.S.

A prospective study has been conducted to assess various known methods in the treatment of Neonatal Tetanus. Out of 100 cases studied over a period of one year the over all mortality was 48%. A substantial reduction in mortality was observed by adding Pyridoxine to the usual regimens. The mortality in this group was 23.7% as compared to 55.13% in controls. The main complications encountered during the course of therapy were aspiration pneumonia, jaundice and septicaemia. The survivors examined in the follow up clinic were found to be mentally normal but 80% of them had umbilical herniae.

A total of 100 babies with Neonatal Tetanus were admitted to the unit from 15 December 1979 to 15 December 1980. All the babies were home delivered, after normal full term pregnancies, their deliveries were conducted by untrained midwives or dais and the cord was severed by a variety of unsterilized instruments. The history of maternal immunization against tetanus was negative in all cases. The umbilicus in 49 cases was found covered by home made ointments, while in 54 cases frank umbilical sepsis was observed. The mean age of developing signs and symptoms of tetanus was 5.2 days and that of reporting to the hospital 8.4 days.

We intend to follow these babies for a period of 5 years for evidence of any residual neurological damage. The survivors followed so far when examined at the ages of 3, 6, 9 and 12 months were found to be mentally normal. Umbilical herniae were found in 80% of these babies, probably due to infection resulting in damage of the umbilical ring and by increase in the intra abdominal pressure during spasms.

Finally, we conclude that the modern methods like artificial respirators, neuromuscular blocking agents, aseptic delivery techniques and ritualistic maternal immunization, though of extreme importance in the treatment of neonatal tetanus, will not be universally available in the forseeable future. Hence the importance of a suitable regimen of treatment. So far the inclusion of pyridoxine in the treatment of Neonatal Tetanus has given promising results and we intend to evaluate its efficacy further.


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