Neonatal tetanus in eastern Uganda: improved outcome following the implementation of a neonatal tetanus protocol

Burgoine, Kathy; Egiru, Emma; Ikiror, Juliet; Acom, Linda; Akol, Sylivia; Olupot‐Olupot, Peter

doi:10.1177/0049475519872860

Cited by 5 publications

(6 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Many studies demonstrate improved outcome of neonatal tetanus after introducing a bundle of care. In Ugandan study, the mortality rate was reduced from 84.6% to 25.0% (P =0.02), after introduction of a protocol that suggest magnesium sulphate and diazepam continuous infusions, broad-spectrum antibiotics and bCPAP (20,21) In a study on eleven cases of neonatal tetanus in Malaysia, all the neonates discharged improved .Early endotracheal intubation and the availability of mechanical ventilation were the main reason for the excellent survival (22).…”

Section: Discussionmentioning

confidence: 99%

Neonatal Tetanus: case series from Dilla univeristy referal hospital, Ethiopia

Bonsa¹,

Kabythmer²,

Tefera³

2022

Ethiop. j. pediatr. child health

View full text Add to dashboard Cite

Background: Neonatal tetanus is a deadly infection leading to 7-8% of neonatal mortality in de-veloping countries. WHO defines Neonatal tetanus as an illness in a child who has the normal ability to suck in the first 2 days of life, presented with failure to suck between 3rd and 28th days of life and has rigidity and spasms? Though Ethiopia declared maternal and neonatal tetanus elimination in 2017, there has been significant number of neonates presenting with this problem in Neonatal ICU’sMethods: This review characterized clinical profile, demography and outcome of seven neona-tal tetanus cases admitted at Dilla University hospital, neonatal ICU from September 11, 2018 to September11, 2020.Results: All mothers gave birth at home with unskilled birth attendant, local blade or knife was used to cut the cord. Median age for mothers was 26 years and two out of seven had antenatal care (ANC) follow up and took Two doses of tetanus toxoid (TT) vaccine. Fever, failure to suck, spasm and convulsions were the common presenting symptoms. The overall mortality was 70%.Conclusion: Continuous emphasis on antenatal tetanus immunization and safe delivery practic-es should be maintained. Clinicians caring for neonates should be aware of the presentations of neonatal tetanus to allow them to diagnose these patients early and initiate appropriate lifesaving management.

show abstract

Section: Discussionmentioning

confidence: 99%

Neonatal Tetanus: case series from Dilla univeristy referal hospital, Ethiopia

Bonsa¹,

Kabythmer²,

Tefera³

2022

Ethiop. j. pediatr. child health

View full text Add to dashboard Cite

show abstract

“…Low-resource settings continue to report high mortality from neonatal tetanus, due to lack of sophisticated management modalities like neuromuscular blockade and invasive ventilation [ 1 – 3 , 6 ]. This high mortality has especially been reported in those with symptom onset within the first week of life [ 3 , 7 ], and in our case symptoms started on the fourth day of life.…”

Section: Discussionmentioning

confidence: 99%

“…Our patient presented with features of autonomic dysfunction (labile heart rate, tachypnea, and hyperpyrexia) and respiratory distress, which has been associated with high mortality in cases of neonatal tetanus [ 4 , 6 , 7 ]. In well-resourced settings, when benzodiazepines alone fail to control spasms, neuromuscular blockage and ventilation are instituted with good outcomes [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Magnesium sulfate causes muscle relaxation, vasodilation, and lowering of heart rate, which can help mitigate autonomic dysfunction [ 9 ] and has been associated with good outcomes in places with limited intensive care [ 6 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although the incidence of neonatal tetanus has decreased over the years with the advent of mass vaccination of women of child-bearing age, the case fatality rate remains high [ 1 , 2 , 4 ]. This is especially true for resource-limited settings without modern intensive care, where mortality can be as high as 80% [ 3 , 5 , 6 ]. This mortality is attributed to autonomic nervous system dysfunction (labile hypertension and unstable heart rate) and spasm of respiratory muscles leading to respiratory failure.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Neonatal tetanus with good outcomes at a regional referral hospital in Eastern Uganda: a case report

et al. 2022

View full text Add to dashboard Cite

Background Neonatal tetanus, though now rare in developed countries, is still a significant cause of mortality in developing countries. Mortality, which can be as high as 100% without medical intervention, can be reduced to less than 10% with intensive care. Low-resource settings still lack sophisticated intensive care that has been shown to improve outcomes in high-income countries. However, there are low-cost interventions that have been shown to improve outcomes such as the use of magnesium sulfate in the management of severe tetanus. Case presentation A 9-day-old term Itesot neonate presented to our facility with inability to breast feed, excessive crying, and stiffening of the body when touched that started on the fourth day of life. On admission, she had signs of respiratory distress, fever, and labile heart rate. A diagnosis of neonatal tetanus with autonomic dysfunction was made, and the neonate was started on diazepam and magnesium sulfate infusion. She showed remarkable improvement and was discharged after 24 days of inpatient care. Conclusion There is still need to improve case management modalities for neonatal tetanus in low-income settings to improve outcomes. This case report summarizes how adopting a low-cost treatment modality for neonatal tetanus resulted in good outcomes at a regional referral hospital in Eastern Uganda.

show abstract