Epidemiological and clinical aspects of neonatal tetanus from a tertiary care hospital

BACKGROUND AND OBJECTIVES: To study the epidemiology, clinical presentation and outcome of all patients diagnosed with neonatal tetanus and to provide a recommendation for maternal and neonatal tetanus elimination. DESIGN AND SETTING: Retrospective study of all cases of neonatal tetanus admitted from 1991 to 2013. Neonatal intensive care unit, King Fahad Central Hospital, Jazan, Saudi Arabia. RESULTS: Thirty patients were diagnosed with neonatal tetanus over 22 years. Eighteen (60%) of the patients were born to Saudi mothers, and 12 (40%) were born to non-Saudi mothers. Twenty-seven (90%) deliveries occurred at home. Most of the mothers lived in the mountainous zone of the region. Two (10%) of the mothers had only a single dose of the tetanus toxoid; the status of the remaining pregnant women was unknown or unimmunized before or during conception. In 18 of the 30 patients (60%), the umbilical cord was severed using household knife, razor blade or plain scissors. Most of the patients presented with muscle spasms (96.7%), refusal to eat and abnormal posture. All of the patients were intubated and receiving mechanical ventilation. Six (20%) of the patients died. CONCLUSION: It is essential to begin campaigns or integrate complete maternal tetanus toxoid immunization at primary health centers (PHC) during antenatal care. Immunization needs to be arranged so pregnant women can be educated regarding the importance of ANC and the risks of unhygienic home delivery, and immunization should be addressed with adequate information. Pregnant women and those of childbearing age in mountainous areas should be the first targets for these activities.