Neonatal Tetanus: demographics, clinical management and outcomes of A Study of 7 Cases in Afghanistan

This study aims to study the demographics, treatment and outcome of neonatal tetanus patients managed at Nangarhar Regional Hospital Afghanistan from June 2019-January 2021. Seventeen neonates were studied. All presented with fever, poor sucking and limb stiffness, with a history of unsterile delivery and uncertain maternal tetanus immunity status. Low-resource settings continue to report high mortality from neonatal tetanus, due to lack of sophisticated management modalities like neuromuscular blockade and invasive ventilation [20-23].The age group of mothers 21-25 of admitted neonates shows high frequency i.e 42.85%. Education of mother of admitted neonates was Primary education i.e 57.14%. 71.42 % (5) mothers not vaccinated. The vaccination awareness should be implemented in community by organising various awareness camp town wise. Government should implement the education mandatory and free for below poverty class and females.

Post Neonatal Tetanus: 20 Years Experience as Seen at the University of Port Harcourt Teaching Hospital.

Aims: To review the status of post neonatal tetanus at University of Port Harcourt Teaching Hospital with a view of highlighting the morbidity and mortality trend. Study Design: Retrospective descriptive study. Place and Duration of Study: Department of Paediatrics, University of Port Harcourt Teaching Hospital between1995-2015. Methodology: This was a 20 year retrospective review of the records of all post neonatal tetanus cases managed at Department of Paediatrics, University of Port Harcourt Teaching Hospital. Results: One hundred and fourteen cases of post neonatal tetanus were studied. Male to female ratio was 1.7:1. The ages ranged from 0.16 to16 years with a mean age of 9.74±4.4 years. Most cases were above 5years of age and either unimmunized or incompletely immunized. The portal of entry was specified in 37 (32.7%) of cases and of these, broomstick injury was the commonest portal of entry accounting for 17 (45.9%). The duration of hospital stay ranged between 1-35 days and case fatality rate was 27.4%. Conclusion: Post neonatal tetanus has remained a major cause of morbidity and mortality in our Teaching Hospital. Injuries especially broomstick injuries predispose to the majority of the cases. Completion of routine tetanus toxoid immunization in infancy and booster doses should be ensured.

Neonatal Tetanus, Yet Not Gone: Infectious Disease Hospital Experience.

Background: Although neonatal tetanus (NT) has been declared eliminated from Bangladesh in June 2008, it is not uncommon in Infectious Disease Hospital (IDH) in Dhaka. There are various presentations of NT cases and treatment practices also vary. Objective: This study was conducted to describe our experiences with NT at IDH outlining the clinical characteristics, maternal immunization and treatment outcome. Materials and Methods: Thirty neonates admitted with tetanus in IDH from March 2011 to December 2012 were observed prospectively to study risk factors, clinical features and outcomes during hospital stay. Results: Among 30 neonates with tetanus 80% were male. Eighty seven percent of these cases were delivered at home and 83% of mothers did not receive any dose of tetanus toxoid (TT). Fifty percent of the neonates were admitted within 3–5 days of age. Shidur (Vermillion) was applied to the cord stump in 23% neonates. Hot soak was applied to the umbilicus in 5 (17%) neonates. Presenting features were convulsion and/or stiffness or rigidity (93%), inability to suck (90%) and umbilical infection (70%). During hospital care multiple cardiac arrests developed in 86% neonates and apnea developed in 60% of the neonates. Treatment was given in pediatric ward. Case fatality rate was 50%. Conclusion: Risk factors observed in NT cases were maternal non-immunization, unhygienic delivery practices and application of substances in the umbilicus. Antenatal TT administration and universal immunization under school health program should be more emphasized to prevent NT.

Analysis on Epidemiological Characteristic and the Influential Factors of Neonatal Tetanus(NNT) in Guangdong Province from 2001-2005 / 中国疫苗和免疫

Objective Analyzing NNT epidemiological characteristics and the influeutial factors in Guangdong province from 2001 to 2005 in order to formulate the strategies for elimination NNT.Methods To make descriptive study on the data collected from NNT surveillance system. Results 2832 cases were concentrated in the Pearl River Delta and the west of Guangdong.About 72.04% NNT cases occurred in the migrant children.Through analyzing the data of the year of 2004 and 2005,73.81% of migrant NNT cases occurred in the Pearl River Delta.The cases happened in the Pearl River Delta accounted for 90.18% of whole cases.Most of local cases occurred in the west of Guangdong,which accounted for 39.04% of local cases.The cases occurred all around the year.A seasonal peak of NNT was found from June to August.Most of the onset of disease were during 2～10 days after birth.There were a higher ratio of reported male cases to the female.The ratio was 2.08∶1.Most of the NNT cases were happened to the infants who delivered at home and most of the midmives who were responsible for delivery lacked of training.99.75% mothers did not kown or administe the tetanus toxoid vaccine. Conclusion The elimination of neonatal tetanus is a difficult task in Guangdong province.Publicity to the mass should be strenghtened.The cooperation between sectors should be conducted for NNT eliminodion.

Nosocomial Pulmonary Infection in Neonates with Tetanus / 中华医院感染学杂志

OBJECTIVE To investigate the major causes and nursing intervention of nosocomial pulmonary infection in neonates with tetanus.METHODS Sputum culture and susceptibility tests were performed in 75 neonates with tetanus.RESULTS Twelve(16%) patients had pulmonary infection during the hospital stay.Nine of them were cured after clinic therapy and nursing intervetion,and the other 3 cases were well improved.CONCLUSIONS Correct treatment and nursing intervention can decrease the occurrence of nosocomial infection and shorten the length of stay.

A Case of Neonatal Tetanus Cured with Neuromuscular Blocking Agent and Ventilatory Support

A neonate born at 38 gestational weeks was admitted due to generalized tonic-clonic seizure and cyanosis. The neonate was born six days previously at home through normal delivery and the umbilical cord was cut using scissors sterilized in boiling water. The neonate weighed 3,180 g at admission. Physical examination revealed cyanosis, opisthotonus, trismus and reactive muscle spasms. Laboratory exam, brain sonogram and EEG showed no significant abnormal findings. Based on her history and physical examination, the neonate was diagnosed with tetanus and put in an incubator isolated in a quiet, dark room. Treatment with tetanus human immunoglobulin along with antibiotics (penicillin G) were started immediately, and mechanical ventilation, administration of neuromuscular blocking agent and muscle relaxant were also started off. The frequency of seizure episode decreased gradually, and on the 32nd hospital day, mechanical ventilatory support was stopped along with extubation two days later. Thereafter, the neonate was in continuous generalized hypertonic state and showed feeding difficulty, but there was gradual improvement. She was dismissed on the 49th hospital day and is currently under OPD follow-up, doing well with no special problems. Respiratory management is critical to neonatal tetanus. We report here a case of tetanus treated with inhibition of self-respiration, neuromuscular blocker and application of ventilator, and present this method as a useful direction for future treatment of neonatal tetanus.

Neonatal tetanus in 2001 at northern region

The study on 2530 cases of neonatal death in the hospitals of 28 northern provinces showed 44 cases of neonatal tetanus, among them 33 deaths. The diseases distributed in 17/28 provinces with a highest incidence (of 1000 live born infants) in Lang Son province. The cases distributed only in 40/306 districts and over all months in the year. They occurred in ethnic minority mothers did not receive adequate vaccines and 94$ of diseases occurred by contagious tool to cut ombilical cordon (6% cut by bambo tool)

La atención prenatal en América Latina / Prenatal care in Latin America

Se revisaron los datos disponibles sobre la cobertura de la atención prenatal en América Latina. En la comparación de las coberturas recientes de atención prenatal entre los países resalta que sólo Bolivia tuvo una cobertura menor al 50 por ciento, mientras que en Chile, Cuba, República Dominicana y Puerto Rico las coberturas de atención prenatal son superiores al 90 por ciento. En relación con las tendencias en el tiempo, se encontró que las coberturas de atención prenatal aumentaron entre los años setenta y ochenta en la República Dominicana, Ecuador, Guatemala, Honduras, México y Perú, mientras que disminuyeron en Bolivia y Colombia. En Cuba y Puerto Rico, aumentó el número de promedio de consultas prenatales. El aumento de la atención en Guatemala y Honduras se debe al aumento relativo del papel de las parteras empíricas, con respecto a las instituciones. Se compararon los datos más recientes sobre la vacunación antitetánica de las embarazadas con los datos más recientes de atención prenatal. Se observa que las tasas de vacuna antitetánica siempre son mucho más bajas que las de atención prenatal, excepto en Costa Rica. En Bolivia, Guatemala y Perú las tasas de vacunación son menores a la mitad de las tasas de atención prenatal. Mejorar el contenido de la atención debe ser objetivo paralelo al aumento de los servicios prenatales.

Available data on the coverage of prenatal care in Latin America were reviewed. In recent years, only Bolivia had a coverage of prenatal care of less than 50 per cent. More than 90 per cent of pregnant women received prenatal care in Chile, Cuba, the Dominican Republic, and Puerto Rico. Prenatal care increased between the 1970 and 1980 in the Dominican Republic, Ecuador, Guatemala, Hon­duras, Mexico, and Peru. The coverage of prenatal care decreased in Bolivia and Colombia. The mean number of visits increased in Cuba and Puerto Rico. The increase of prenatal care in Guatemala and Honduras is due to increased care by traditional birth attendants, compared to the role of health care institutions. We compared the more recent data on tetanus immunization of pregnant women to the more recent data on prenatal care. The rates of tetanus immunization are always lower than the rates of prenatal care attendance, except in Costa Rica. The rates of tetanus immunization was less than half as compared to the rates of prenatal care in Bolivia, Guate­mala, and Peru. To improve the content of prenatal care should be an objective complementary to the increase of the number of attending women.