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

Abstract

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.

Neonatal mortality and associated factors among newborns in Mogadishu, Somalia: a multicenter hospital-based cross-sectional study

“…Neonatal tetanus is also a high mortality risk due to underdeveloped immune systems and muscle spasms, which can result in respiratory failure and death. A study in Uganda reported that neonatal tetanus cases caused high mortality rates among newborns [63], supporting this observation. Furthermore, poor people in the study area often use unsterilized tools or contaminated substances to cut the umbilical cord, increasing the risk of bacteria entering the baby's body and potentially leading to adverse outcomes, including death [64].…”

Tetanus Neonatorum: its Associated Risk Factors and Mortality Rate in Khyber Pakhtunkhwa

“…This high death rate has been documented most frequently in infants whose symptoms began within the first week of life. Early disease onset may be owing to increased C. tetani bacterial inoculates and younger newborns were physiologically at high risk of death 10 .…”

Generalized tetanus: a pediatric case report and literature review

“…Muscle spasms can be very painful and are frequently triggered by stimulation 26 . Tachycardia, bradycardia, blood pressure changes and arrhythmias can all be symptoms of autonomic instability 17 . The spasms last for three to four weeks.…”

“…Conversely, some other reports in the literature claim that people with minor or subtle wounds may potentially contract a tetanus infection 12 . According to our literature review in Table 1, one pediatric patient who developed tetanus did not report an injury or wound 17 .…”

“…Human TIG neutralizes the unbound toxin 5,12 . Intramuscular or intravenous equine antitoxin is a suitable alternative if HTIG is not provided 17 . If equine antitoxin is used, skin testing should be done before giving the full dose to exclude hypersensitivity effects 29 .…”