NEONATAL TETANUS EXPERIENCE AT THE NATIONAL INSTITUTE OF PEDIATRICS IN MEXICO-CITY

Clinical charts of 44 neonates admitted to the National Institute of P ediatrics with the diagnosis of neonatal tetanus from 1970 to 1990 wer e reviewed. All patients had an epidemiologic and clinical findings co mpatible with neonatal tetanus. Delivery had occurred at the homes of the patients in 89% of the cases and in 11% at clinics. The incubation periods ranged from 2 to 10 days, with a mean of 6.2 days. Cole's per iods varied from 1 to 144 hours, with a mean of 21 hours. Spasticity, irritability, refusal to feed, lack of sucking and trismus were presen t in all cases. Thirty-three patients (70.4%) developed complications, the most frequent being sepsis and bronchopneumonia. The most frequen t noninfectious complication was atelectasis, followed by renal failur e and electrolytic imbalance. Overall mortality was 25%. It is notewor thy that in the most recent decade (1980 to 1990) mortality was 12.9%, considerably lower than that of the previous decade (1970 to 1980) wh ich was 46.6% (P < 0.008). This decrease was probably a result of the greater availability of mechanical ventilation and the intensive care offered at neonatal services. Mortality was associated with the severi ty of the disease (P < 0.003) and with the presence of complications ( P < 0.025).