Neonatal tetanus in St. Mary’s Hospital Lacor: A case report

Okidi, Ronald; Sambo, Vanusa Da Consolação; Eyul, Jacob

doi:10.1002/ccr3.3091

Cited by 5 publications

(7 citation statements)

References 13 publications

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“…There are some case reports supporting the use of phenobarbital in generalized and neonatal tetanus, although some of them have shown no mortality benefit. 16 A meta-analysis of studies on children with tetanus reported diazepam alone is more beneficial on controlling tenues and reducing mortality than if it is combined with phenobarbital (RR of death 0.36; 95% CI 0.15-0.86; risk difference 12.22; 95% CI −0.38 to −0.06). 17 However, the combination of diazepam and phenobarbital compered to diazepam alone has demonstrated a significantly shorter clinical course and hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…Since the patient's spasms began to decrease after propofol administration, and also due to the concern about the probability of propofol infusion syndrome, we decided to change it to intravenous phenobarbital, with regards to similarity in the antispasmodic mechanism of these agents. There are some case reports supporting the use of phenobarbital in generalized and neonatal tetanus, although some of them have shown no mortality benefit 16 . A meta‐analysis of studies on children with tetanus reported diazepam alone is more beneficial on controlling tenues and reducing mortality than if it is combined with phenobarbital (RR of death 0.36; 95% CI 0.15–0.86; risk difference 12.22; 95% CI −0.38 to −0.06) 17 .…”

Section: Discussionmentioning

confidence: 99%

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Successful management of severe generalized tetanus in a 23‐year man with phenobarbital adjuvant: A case report

Ahmadi,

Karimpour‐Razkenari,

Ansari

et al. 2023

Clinical Case Reports

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Key Clinical MessageGeneralized tetanus is still a global concern with a mortality rate of up to 50%, especially in low and middle‐income countries. We reported a 23‐year‐old man from Afghanistan admitted to emergency department, with the chief complaint of generalized severe spasms and lockjaw. The patient had skin lesions and had never been vaccinated against tetanus. He intubated and admitted to the intensive care unit (ICU) with diagnose of severe generalized tetanus. After receiving tetanus immunoglobulin and intravenous metronidazole, a combination therapy of midazolam, propofol, atracurium, and morphine was administered. Due to the refractory muscular spasms intravenous phenobarbital started and little by little recovery was achieved. The patient receiving the first two doses of the Td vaccine, and discharged on Day 42 of hospitalization with no symptom recurrence. This case management showed adding phenobarbital to severe tetanus treatment regimen could significantly reduce refractory spasm caused by tetanus, also decrease other medication requirement.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful management of severe generalized tetanus in a 23‐year man with phenobarbital adjuvant: A case report

Ahmadi,

Karimpour‐Razkenari,

Ansari

et al. 2023

Clinical Case Reports

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“…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. Earlier presentation with disease may be due to higher inocula of C. tetani bacteria, and/or younger infants may be physiologically at higher risk of death [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Neonatal tetanus, though preventable by maternal vaccination and aseptic delivery as well as cord care, is still a common cause of morbidity and mortality in developing countries [ 1 – 3 ]. It is caused by a toxin of Clostridium tetani , a Gram-positive spore-forming anaerobe and its incubation period ranges from 3 to 10 days.…”

Section: Introductionmentioning

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%

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

et al. 2022

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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.

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

Ali,

Inchon,

Suwannaporn

et al. 2024

BMC Public Health

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Introduction Neonatal mortality is a significant public health problem in Sub-Saharan Africa, particularly in Somalia, where limited data exists about this. Mogadishu, the densely populated capital, faces a high rate of neonatal mortality, but this has not been widely studied on a national level. Healthcare providers and policymakers are working to reduce newborn deaths, but a comprehensive understanding of the contributing factors is crucial for effective strategies. Therefore, this study aims to determine the magnitude of neonatal death and identify factors associated with it in Mogadishu, Somalia. Method A multicenter hospital-based cross-sectional study was conducted to collect data from participants at 5 purposively selected hospitals in Mogadishu, Somalia. A well-structured, reliable, self-developed, validated questionnaire containing socio-demographic, maternal, and neonatal characteristics was used as a research tool. Descriptive statistics were used for categorical and continuous variables presented. Chi-square and logistic regression were used to identify factors associated with neonatal mortality at a significant level of α = 0.05. Results A total of 513 participants were recruited for the study. The prevalence of neonatal mortality was 26.5% [95%CI = 22.6–30.2]. In a multivariable model, 9 variables were found: female newborns (AOR = 1.98, 95%CI = 1.22–3.19), those their mothers who did not attend ANC visits (AOR = 2.59, 95%CI = 1.05–6.45), those their mothers who did not take tetanus toxoid vaccination (AOR = 1.82, 95%CI = 1.01–3.28), those their mothers who delivered in instrumental assistant mode (AOR = 3.01, 95%CI = 1.38–6.56), those who had neonatal sepsis (AOR = 2.24, (95%CI = 1.26–3.98), neonatal tetanus (AOR = 16.03, 95%CI = 3.69–69.49), and pneumonia (AOR = 4.06, 95%CI = 1.60–10.31) diseases during hospitalization, premature (AOR = 1.99, 95%CI = 1.00–3.94) and postmature (AOR = 4.82, 95%CI = 1.64–14.16) neonates, those with a birth weight of less than 2500 gr (AOR = 4.82, 95%CI = 2.34–9.95), those who needed resuscitation after delivery (AOR = 2.78, 95%CI = 1.51–5.13), and those who did not initiate early breastfeeding (AOR = 2.28, 95%CI = 1.12–4.66), were significantly associated with neonatal mortality compared to their counterparts. Conclusion In this study, neonatal mortality was high prevalence. Therefore, the intervention efforts should focus on strategies to reduce maternal and neonatal factors related to neonatal mortality. Healthcare workers and health institutions should provide appropriate antenatal, postnatal, and newborn care.

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Neonatal tetanus in St. Mary’s Hospital Lacor: A case report

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 5 publications

References 13 publications

Successful management of severe generalized tetanus in a 23‐year man with phenobarbital adjuvant: A case report

Successful management of severe generalized tetanus in a 23‐year man with phenobarbital adjuvant: A case report

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

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

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