Department of Paediatrics and Child Health, Soroti Regional Referral Hospital, P.O Box 289, Soroti, Uganda.
Soroti Regional Referral Hospital, Soroti, Uganda.
J Med Case Rep. 2022 Jan 31;16(1):54. doi: 10.1186/s13256-022-03255-4.
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.
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.
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.
新生儿破伤风虽然在发达国家已罕见,但在发展中国家仍是一个重要的死亡原因。如果不进行医疗干预,死亡率可高达 100%,但通过重症监护可将死亡率降低至 10%以下。资源匮乏的地区仍缺乏已被证明可改善高收入国家结局的复杂重症监护。然而,一些低成本的干预措施已被证明可改善结局,例如在严重破伤风的治疗中使用硫酸镁。
一名 9 天大的足月 Itesot 新生儿,在生后第 4 天开始出现无法母乳喂养、过度哭泣和触碰时身体僵硬的症状。入院时,她有呼吸窘迫、发热和心率不稳定的体征。诊断为伴有自主神经功能障碍的新生儿破伤风,给予地西泮和硫酸镁静脉滴注。她的病情显著改善,在住院 24 天后出院。
在低收入环境中,仍需要改进新生儿破伤风的病例管理方式以改善结局。本病例报告总结了在乌干达东部的一家地区转诊医院中,采用一种低成本的新生儿破伤风治疗方法如何取得良好结局。