Neonatal tetanus experience at the National Institute of Pediatrics in Mexico City

Clinical charts of 44 neonates admitted to the National Institute of Pediatrics with the diagnosis of neonatal tetanus from 1970 to 1990 were reviewed. All patients had an epidemiologic and clinical findings compatible 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 periods varied from 1 to 144 hours, with a mean of 21 hours. Spasticity, irritability, refusal to feed, lack of sucking and trismus were present in all cases. Thirty-three patients (70.4%) developed complications, the most frequent being sepsis and bronchopneumonia. The most frequent noninfectious complication was atelectasis, followed by renal failure and electrolytic imbalance. Overall mortality was 25%. It is noteworthy that in the most recent decade (1980 to 1990) mortality was 12.9%, considerably lower than that of the previous decade (1970 to 1980) which 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 severity of the disease (P < 0.003) and with the presence of complications (P < 0.025).