Azher Abbas Shah, Agha Shabbir Ali, Rana Rashid Hussain, Abid Hussain, Anjum Saeed, Tayyaba Khawar Butt.
Complications and outcome of neonatal tetanus.
Pak Paed J Jan ;31(3):126-31.

Introduction: Neonatal tetanus is a major problem in Pakistan, being one of the common causes of neonatal deaths especially in the rural areas where deliveries are conducted at home by Dais in unhygienic conditions and vaccination status of the mothers is not very encouraging. Objectives: The case series was conducted to find out complications, clinical course and outcome of neonatal tetanus. Methodology: It was conducted at the department of Neonatology of the Children`s Hospital and the Institute of Child Health, Lahore. This case series was carried out in a prospective manner. The sample size consisted of fifty neonates who presented with neonatal tetanus over one year. Diagnosis of neonatal tetanus was established exclusively on clinical grounds. Results: Male to female ratio was 7.3:1. Eighty percent of the cases were home delivered and in 88% cases, mothers were not vaccinated against tetanus. The umbilical cord was cut with blade in 60% and Desi Ghee was applied to the umbilical stump in 20% of cases. All the fifty neonates had poor sucking. Opisthotonos was noted in 84% cases while lock jaw was present in 78% neonates. Regarding complications, 19 patients developed aspiration pneumonia, 12 developed Jaundice, 18 neonates developed intractable fits and 12 developed acute renal failure. The overall mortality in this study was 50%; the patients who were ventilated mechanically had a mortality rate of 46.66% while those who were not ventilated had a mortality of 52.63%. The patients with shorter incubation period i.e less than 7 days (33 patients) had a worst out come with a statistically significant p-value (p <0.001). There was 100% mortality among the premature neonates with tetanus in contrast with 44.4% mortality amongst the full term neonates. Conclusion: Our experience in this study revealed that lack of tetanus immunization of mothers along with unsafe and unhygienic delivery practices are major factors responsible for the development of this disease. Wile short incubation period, prematurity and opisthotonos are associated with high mortality.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com