Parashar U D, Bennett J V, Boring J R, Hlady W G
Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Int J Epidemiol. 1998 Oct;27(5):904-8. doi: 10.1093/ije/27.5.904.
Previous case-control studies of neonatal tetanus (NNT), a leading cause of infant mortality in developing countries, have suggested that antimicrobials applied after delivery to the umbilical cord stump may protect against this disease. However, assessment of their protective effect has been limited by the low prevalence of antimicrobial use in developing countries.
We conducted a population-based, matched, case-control study to assess the use of antimicrobials and other factors potentially related to NNT in rural parts of Bangladesh. We studied 359 cases (infants who were normal at birth but who died between the 3rd and 30th day of life after an illness characterized by signs of NNT), each matched to three living controls for gender, residence, and date of birth.
In univariate analyses, the application of either antibiotics or disinfectants at delivery, and the continuous or any application of disinfectants were protective against NNT. The application of antibiotics at delivery (odds ratio [OR] = 0.21, P = 0.019), hand washing by the delivery attendant (OR = 0.64, P = 0.005), and prior maternal immunization with tetanus toxoid (OR = 0.50, P < 0.001) remained protective in conditional logistic-regression analyses. Application of animal dung to the umbilical stump (OR = 2.31, P = 0.047) was hazardous.
Effective and inexpensive topical antimicrobials provide a new prevention opportunity that could be used by traditional birth attendants and mothers to provide additional benefits to NNT control programmes based on maternal immunization with tetanus toxoid. Promotion of hygienic delivery and cord-care practices and increasing tetanus toxoid coverage remain cornerstones for the prevention of NNT deaths.
新生儿破伤风是发展中国家婴儿死亡的主要原因，以往的病例对照研究表明，分娩后应用于脐带残端的抗菌药物可能预防这种疾病。然而，在发展中国家，抗菌药物使用率较低限制了对其保护作用的评估。
我们开展了一项基于人群的配对病例对照研究，以评估孟加拉国农村地区抗菌药物的使用情况以及其他可能与新生儿破伤风相关的因素。我们研究了359例病例（出生时正常但在出现新生儿破伤风体征的疾病后于出生后第3天至第30天死亡的婴儿），每例病例按性别、居住地和出生日期与3名存活对照进行匹配。
在单因素分析中，分娩时应用抗生素或消毒剂，以及持续或任何时候应用消毒剂均可预防新生儿破伤风。在条件逻辑回归分析中，分娩时应用抗生素（比值比[OR]=0.21，P=0.019）、接生员洗手（OR=0.64，P=0.005）和母亲既往接种破伤风类毒素（OR=0.50，P<0.001）仍具有保护作用。在脐带残端涂抹动物粪便（OR=2.31，P=0.047）有危害。
有效且廉价的局部抗菌药物提供了一个新的预防机会，传统接生员和母亲可以利用这一机会为基于母亲接种破伤风类毒素的新生儿破伤风控制项目带来额外益处。推广卫生分娩和脐带护理做法以及提高破伤风类毒素接种覆盖率仍然是预防新生儿破伤风死亡的基石。
