Brain damage after neonatal tetanus in a rural Kenyan hospital

OBJECTIVE Neonatal tetanus (NNT) is an important cause of mortality in reso urce poor countries, particularly sub-Saharan Africa. There are no reports of the long-term outcome of children who survive NNT in African hospitals. DESIGN In a retrospective study of children discharged from Kilifi District Hospital (KDH), Kenya with NNT, each child was linked with a comparative c hild (CC) in the community matched for age, sex and locality. PARTICIPANTS A total of 123 patients were admitted with NNT between 1992 an d 1996, of whom 68% died. Twenty-three (59%) of the 39 survivors were trace d in the community, 10 had moved away, six had died. OUTCOME MEASURES NNT survivors underwent a neurological and developmental e xamination and a questionnaire was administered to the parents about the be haviour of the child. A verbal autopsy was used to determine the cause of d eath in children who had died after discharge. RESULTS The head circumference of NNT survivors was significantly smaller t han that of CC (P=0.037); eight children had microcephaly compared with one CC (P=0.011). NNT survivors had more problems with hand-eye co-ordination tasks (P=0.035), a lower summated developmental score (P=0.023) and more mi ld neurological abnormalities (P=0.008) than CC. Parents of NNT survivors r eported more behavioural problems (P=0.02) than parents of CC. CONCLUSIONS Children who survive NNT have evidence of brain damage that man ifests as microcephaly, mild neurological abnormalities, developmental impa irment - particularly fine motor difficulties - and behaviour problems.