Factors Affecting Prognosis of Neonatal Tetanus

Gürses, N.; Aydın, Mesiya

doi:10.3109/00365549309008510

Cited by 14 publications

(11 citation statements)

References 6 publications

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“…An incubation period of 6 days (Einterz & Bates 1991) or 10 days (Gurses & Aydin 1993) or less has previously been reported as significantly associated with death. A short incubation period may indicate increased virulence of infectious agent or decreased host resistance, both factors that would tend to increase mortality from infection.…”

Section: Discussionmentioning

confidence: 95%

“…It is accepted that maternal immunization with at least two doses of TT (TT2) not only reduces incidence but also protects from death from NNT (Taha et al 1993;Owa & Makinde 1990). On the other hand, poor cord care, short incubation period, male sex and severity of the disease have all been variously proposed as indicators of an unfavourable outcome (Stanfield & Galazka 1984;Taha et al1993;Einterz & Bates 1991;Osinusi et al 1986;Saltigeral Simental et al 1993;Gurses & Aydin 1993;Eregie & Ofovwe 1995).…”

Section: Introductionmentioning

confidence: 99%

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Prognostic factors in neonatal tetanus

Davies‐Adetugbo

Torimiro

Ako-Nai

1998

Tropical Med Int Health

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SummaryOBJECTIVE Neonatal tetanus (NNT) is the leading cause of neonatal deaths in developing countries. The objective of this study was to determine prognostic indicators in NNT. METHODS We reviewed the clinical records of all neonates (n ϭ 174) admitted to Ife State Hospital with the diagnosis of NNT from 1991 through 1995. RESULTS Delivery had occurred at home in 73.3% of cases. Only 37/164 of the mothers had had adequate immunization with tetanus toxoid. The umbilical cord appeared to be the portal of entry in 58.6% of cases. Mean age of infants at presentation was 7.2 days. Mortality was 57.5%; non-survivors succumbed after mean stay in the hospital of 5.0 days. Mortality was significantly associated with an incubation period of 6 days or less (P ϭ 0.0026), infant's weight of less than 2.5 kg (P ϭ 0.0113), lack of antenatal care in a health facility (P ϭ 0.0279), birth at home (P ϭ 0.0455), but not with lack of adequate maternal immunization (P = 0.2081; not significant). Multivariable analysis showed that a short (р 6 d) incubation period was the strongest predictor of mortality (OR ϭ 3.11, P ϭ 0.0030) while low infant weight (Ͻ 2.5 kg) was also a significant predictor (OR ϭ 2.46, P ϭ 0.0408). CONCLUSIONS Hygienic deliveries and adequate cord care are very important for the prevention of neonatal tetanus deaths, and universal prenatal care, including education programmes on appropriate perinatal and cord care, can significantly reduce NNT incidence and mortality in developing countries.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Prognostic factors in neonatal tetanus

Davies‐Adetugbo

Torimiro

Ako-Nai

1998

Tropical Med Int Health

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“…1993). In published studies mortality ranges from 20 to 90%; the higher rates occur in hospitals that cannot provide ventilatory support (Gurses & Aydin 1993; Jeena et al . 1997).…”

Section: Introductionmentioning

confidence: 99%

“…Surveys from Kenya in the late 1980s estimated that 8000±12 000 neonates die from NNT every year (Melgaard et al 1988;Bjerregaard et al 1993). In published studies mortality ranges from 20 to 90%; the higher rates occur in hospitals that cannot provide ventilatory support (Gurses & Aydin 1993;Jeena et al 1997). As mortality is high, the emphasis has been on death.…”

Section: Introductionmentioning

confidence: 99%

Brain damage after neonatal tetanus in a rural Kenyan hospital

Barlow

Mung’ala‐Odera

Gona

et al. 2001

Tropical Med Int Health

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Summary OBJECTIVEOBJ ECTIVE Neonatal tetanus (NNT) is an important cause of mortality in resource poor countries, particularly sub-Saharan Africa. There are no reports of the long-term outcome of children who survive NNT in African hospitals. D ESIGNDESIG N In a retrospective study of children discharged from Kili® District Hospital (KDH), Kenya with NNT, each child was linked with a comparative child (CC) in the community matched for age, sex and locality.PARTICIPANTS PARTICIPANTS A total of 123 patients were admitted with NNT between 1992 and 1996, of whom 68% died. Twenty-three (59%) of the 39 survivors were traced in the community, 10 had moved away, six had died. OUTCOME OUT COME MEASURES MEASURES NNT survivors underwent a neurological and developmental examination and a questionnaire was administered to the parents about the behaviour of the child. A verbal autopsy was used to determine the cause of death in children who had died after discharge. RESULTSRES ULTS The head circumference of NNT survivors was signi®cantly smaller than that of CC (P 0.037); eight children had microcephaly compared with one CC (P 0.011). NNT survivors had more problems with hand±eye co-ordination tasks (P 0.035), a lower summated developmental score (P 0.023) and more mild neurological abnormalities (P 0.008) than CC. Parents of NNT survivors reported more behavioural problems (P 0.02) than parents of CC. CONCLUSIONS CONCLUSIONS Children who survive NNT have evidence of brain damage that manifests as microcephaly, mild neurological abnormalities, developmental impairment ± particularly ®ne motor dif®culties ± and behaviour problems.

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“…O TN deve ser diferenciado de outras patologias como crises convulsivas neonatais, meningite e kernicterus 5 . O prognóstico é reservado se a criança, na hora da admissão, tem idade inferior a dez dias, com sintomas há mais de cinco dias, riso sardônico e febre 10 . Alguns autores referem que peso ao nascer não altera o prognóstico 5,11 , enquanto outros afirmam que peso inferior a 2.500kg tem maior mortalidade 11 .…”

Section: Discussionunclassified

Intensive phototherapy treatment for severe haemolytic disease of the newborn

Facchini¹,

Bianchi²,

Silva³

2000

J Pediatr (Rio J)

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ResumoObjetivo: O tétano neonatal é uma infecção com alta mortalidade, constituindo-se um problema em países subdesenvolvidos, onde há deficiente assistência pré-natal. A despeito desse fato e da decrescente incidência da doença no estado do Rio Grande do Sul, relata-se um caso de tétano neonatal ocorrido em 1997.Métodos: Entrevista da mãe e verificação de seu estado vacinal, exame clínico do recém-nascido, exame cultural de coto umbilical e revisão do prontuário médico. Revisão da literatura e verificação do perfil epidemiológico do tétano neonatal no Rio Grande do Sul.Resultados: Mãe saudável, com esquema completo de vacina antitetânica há 4 anos, pré-natal sem intercorrências e parto hospitalar. Família de bom nível socioeconômico, diferenciando-se dos demais casos notificados no Estado, em que a maioria não teve acompanhamento pré-natal nem parto hospitalar. O paciente é um menino que no 24º dia de vida iniciou com febre, crises de cianose, hipertonia dos membros superiores e inferiores e opistótono. Crescimento de Clostridium tetani ao exame cultural de secreção do coto umbilical. Tratado com penicilina G, gentamicina, sedação e antitoxina tetânica. Alta em boas condições.Conclusões: A deficiente assistência pré-natal em países subdesenvolvidos é o maior fator de risco para a elevada incidência da doença nestas regiões. Contudo, em gestantes com bom nível socioconômico e acompanhamento pré-natal, como ocorre no caso descrito, o diagnóstico não deve ser excluído diante da constatação de sinais sugestivos. AbstractObjective: Neonatal tetanus is an infection with high mortality, constituting a problem in underdeveloped countries, where there is faulty prenatal attendance. In spite of this and of the decreasing incidence of the disease in the state of Rio Grande do Sul, we report a case of neonatal tetanus identified in 1997.Method: We interviewed the infant's mother and verified her vaccination history. We conducted a clinical examination of the newborn, anaerobic culture of umbilical stump and review of medical records. We also reviewed the literature and verified the epidemic profile of neonatal tetanus in Rio Grande do Sul.Results: Healthy mother, with complete outline of tetanus vaccination 4 years ago, prenatal uncomplicated and hospital delivery. Family of good socioeconomic level, differing from the other cases notified in the State, in that most did not have prenatal care nor hospital delivery. The patient is a boy. In the 24 th day of life he presented fever, cyanosis, lower and upper limbs muscle hypertonia and opisthotonos episodes. An anaerobic culture of the umbilical stump grew Clostridium tetani. He was treated with penicillin G, gentamicin, sedation and tetanus immunoglobulin. He left hospital in good conditions.Conclusions: Faulty prenatal care in underdeveloped countries is the largest risk factor for high incidence of this disease in these areas. However, in pregnant women with good socioeconomic level and prenatal care, as in the case described here, this diagnosis should not be excluded i...

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Factors Affecting Prognosis of Neonatal Tetanus

Cited by 14 publications

References 6 publications

Prognostic factors in neonatal tetanus

Prognostic factors in neonatal tetanus

Brain damage after neonatal tetanus in a rural Kenyan hospital

Intensive phototherapy treatment for severe haemolytic disease of the newborn

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