Prognostic factors in neonatal tetanus

Abstract

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.

Risk factors for mortality in neonatal tetanus: a 15-year experience in Sagamu, Nigeria

“…The overall CFR in a 15-year period in this study was higher than 43.8% reported from Ilesha, Nigeria [7] but comparable to 57.7% reported from Ile-Ife, Nigeria [12] and 52% from Turkey. [13] Interestingly, it was lower than 66.3% reported from North Bengal, India.…”

Prevalence and outcome of neonatal tetanus in Zaria, Northwestern Nigeria

“…However, some cases of neonatal tetanus could present with a short incubation period that may not allow the caregiver to have ample time to prepare for early hospital attendance. Furthermore, the incubation period in most of those with fatal outcome was short which itself connotes poor prognosis [15]. The reason for the shorter incubation period in the present study is not certain but may be related to the high prevalence of traditional uvulectomy in the study population.…”

Intensive phototherapy treatment for severe haemolytic disease of the newborn

“…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 . Davies e cols.…”

“…Nestes casos, as prováveis causas da ineficácia da vacina sugeridas foram erro no intervalo de administração entre a primeira e a segunda dose, a administração de apenas uma dose, o que reduz a efetividade da vacina para 70%, ou a má resposta imune da mãe. A carência de vitamina A e infecção materna por Plasmodium falciparum podem diminuir a resposta imune ao TT em gestantes vacinadas 11 .…”