Prognostic factors in neonatal tetanus

OBJECTIVE 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 = 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 toroid. 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 = 0.0026), infant's weight of less than 2.5 kg (P = 0.0113), lack of antenatal care in a health facility (P = 0.0279), birth at home (P = 0.0455), but not with lack of adequate maternal immunization (P = 0.2081; not significant). Multivariable analysis showed that a short (less than or equal to 6 d) incubation period was the strongest predictor of mortality (OR = 3.11, P = 0.0030) while low infant weight (< 2.5 kg) was also a significant predictor (OR = 2.46, P = 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.