Bennett J, Azhar N, Rahim F, Kamil S, Traverso H, Killgore G, Boring J
Task Force for Child Survival and Development, Carter Center, Atlanta, GA 30307, USA.
Int J Epidemiol. 1995 Jun;24(3):643-7. doi: 10.1093/ije/24.3.643.
Previous case-control studies of neonatal tetanus (NNT) in the North West Frontier Province of Pakistan indicated that clarified butter (ghee) applied to the umbilical wound of newborns was a significant risk factor for NNT. However, the mechanisms underlying the risk remained undisclosed.
A hospital-based case-control study was undertaken to evaluate further ghee and other factors possibly associated with risk of NNT. Mothers of several recent ghee-associated cases were visited in their homes, asked to simulate the procedures used in preparing the ghee, and samples of ghee were collected for culture.
Topical application of ghee to the umbilical wound was again shown to pose a significant risk for NNT. In-use contamination of ghee was documented as mothers repeatedly heated and manipulated samples of ghee set aside in special containers for this purpose. Ghee was usually applied to the umbilical wound of the baby several times each day for the first few days of life. Mothers of cases were again confirmed to be substantially more likely to report prior NNT cases than mothers of controls.
Educational interventions to reduce umbilical ghee use or to wash hands before each manipulation might reduce the risk of NNT in babies exposed to ghee who are born to non-immunized mothers. Increased efforts to immunize women of childbearing age with tetanus toxoid are also needed, with special priority for mothers known to have been associated with a previous NNT case. Topical antibiotics should be further evaluated for protective effects in non-immunized mothers.
此前在巴基斯坦西北边境省开展的新生儿破伤风（NNT）病例对照研究表明，给新生儿脐部伤口涂抹酥油是新生儿破伤风的一个重要危险因素。然而，该危险因素背后的机制仍不明确。
开展了一项基于医院的病例对照研究，以进一步评估酥油及其他可能与新生儿破伤风风险相关的因素。走访了近期几例与酥油有关病例的母亲，让她们在家中模拟制作酥油的过程，并采集酥油样本进行培养。
再次表明给脐部伤口局部涂抹酥油会带来显著的新生儿破伤风风险。有记录显示，由于母亲们反复加热并处理为此专门放在特殊容器中的酥油样本，酥油在使用过程中受到了污染。在婴儿出生后的头几天，通常每天会给婴儿脐部伤口涂抹几次酥油。病例组母亲报告有既往新生儿破伤风病例的可能性再次被证实显著高于对照组母亲。
开展教育干预，减少脐部酥油的使用或在每次操作前洗手，可能会降低未接种疫苗母亲所生、接触过酥油的婴儿患新生儿破伤风的风险。还需要加大力度为育龄妇女接种破伤风类毒素，对于已知有过新生儿破伤风病例的母亲应给予特别优先考虑。应进一步评估局部使用抗生素对未接种疫苗母亲的保护作用。
