Prognostic factors and outcome of neonatal tetanus.

Abstract

Objective: To determine prognostic factors and outcome of neonatal tetanus (NT). Study Design: Analytical, Cross-sectional study. Setting: Neonatal Intensive Care Unit (NICU) of the National Institute of Child Health, Karachi, Pakistan. Period: January 2024 to March 2025. Methods: A total of 154 neonates (gestational age > 34 weeks) admitted to the NICU due to NT for more than 24 hours were studied. Outcomes in terms of discharged or mortality were assessed. Data were analyzed using IBM-SPSS version 26.0. For all inferential statistics computed by applying chi-square test, fisher’s exact test or independent sample t-test (as appropriate), p<0.05 was considered as statistically significant. Results: Of 113 neonates with tetanus, 18 (15.9%) were discharged while 95 (84.1%) died. Survivors had a higher mean age at presentation (12.11±1.91 vs. 8.54±3.08 days, p<0.001), and longer incubation period (10.20±2.18 vs. 4.38±2.69 days, p<0.001). Severe disease (p<0.001), lack of maternal immunization (p=0.009), and use of a blade for cord cutting (p=0.006), were associated with higher mortality. Mechanical ventilation was required in all non-survivors (100% vs. 77.8%, p<0.001). Survivors had a longer total hospital stay (18.94±5.48 vs. 15.08±4.75 days, p=0.003). Conclusion: Neonatal tetanus remains a devastating disease in the Pakistani context, with a persistently high case fatality. Early age at presentation, short incubation period, severe clinical disease, non-immunized mothers, unsafe delivery practices, and use of unsterilized tools for cord cutting are the dominant prognostic factors for mortality.