Abstract

Objective The aim of this study was to evaluate mortality rate and prognostic factors in neonatal tetanus cases presented to Turkey-Somalia Mogadishu Training and Research Hospital

Methods A total of 35 neonatal tetanus cases presented to Turkey-Somalia Mogadishu Training and Research Hospital between 2014 and 2017 were included in this prospective observational study. Data on demographic, clinical and maternal obstetric characteristics, and laboratory findings including complete blood count and blood biochemistry were recorded in each patient. Study parameters were evaluated with respect to survivorship status, while multiple logistic regression analysis was performed to determine independent predictors of increased mortality risk.

Results Overall, mortality occurred in 22 (62.9%) of 35 neonates diagnosed with neonatal tetanus. Tetanus prophylaxis was absent in the majority of neonates, regardless of survivorship status (100.0% in nonsurvivors vs. 84.6% in survivors, p = 0.131). In nonsurvivor versus survivor groups, significantly higher likelihood of constipation (50.0 vs. 7.7%, p = 0.002), contracture (81.8 vs. 46.2%, p = 0.035), and ventilator support (95.4 vs. 53.8%, p = 0.006) as well as significantly lower hemoglobin (14.45 ± 2.06 vs. 17.15 ± 1.77, p = 0.003) and potassium (3.50 ± 0.86 vs. 4.14 ± 0.93, p = 0.003) levels and neutrophil (3.34 ± 1.75 vs. 4.47 ± 1.08, p = 0.047, white blood cell (WBC) (5.54 ± 2.30 vs. 7.78 ± 1.70, p = 0.003) and platelet (median [min-max] 133.5 [68–332] versus 196 [123–550], p = 0.006) counts were noted. Presence of contracture (odds ratio [OR]: 14.525, 95% confidence interval [CI]: 1.398–150.870, p = 0.025) and ventilator support (OR: 22.282, 95% CI: 1.269–391.131, p = 0.034) was the independent determinants of increased risk of mortality.

Conclusion Our findings emphasize high mortality in neonatal tetanus cases in Somalia along with lack of maternal tetanus prophylaxis in majority of cases. Presence of contractures and ventilator support were significant determinants of poor survival, while factors such as constipation, lower hemoglobin, and potassium levels and lower neutrophil, WBC and platelet counts were also more common among nonsurvivors, albeit not found to be associated with mortality risk in the multivariate analysis.

Publication History

Received: 05 April 2020

Accepted: 12 August 2020

Publication Date:
21 September 2020 (online)

Georg Thieme Verlag KG
Stuttgart · New York

中文翻译：

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新生儿破伤风死亡率和预后因素：土耳其-索马里摩加迪沙培训研究医院的病例三年分析

摘要

目的 本研究的目的是评估在土耳其-索马里摩加迪沙培训研究医院就诊的新生儿破伤风病例的死亡率和预后因素

方法 这项前瞻性观察研究纳入了2014年至2017年间在土耳其-索马里摩加迪沙培训研究医院就诊的35例新生儿破伤风病例。记录每位患者的人口统计学，临床和产妇产科特征数据以及实验室检查结果，包括全血细胞计数和血液生化指标。就生存状况评估了研究参数，同时进行了多个逻辑回归分析以确定死亡率升高的独立预测因子。

结果 总体上，在35例诊断为新生儿破伤风的新生儿中，有22例（62.9％）发生了死亡。不论幸存者的状况如何，大多数新生儿都没有预防破伤风的发生（非幸存者中为100.0％，幸存者中为84.6％，p  = 0.131）。在非幸存者和幸存者组中，发生便秘的可能性更高（50.0比7.7％，p  = 0.002），挛缩（81.8 vs. 46.2％，p  = 0.035）和呼吸机支持（95.4 vs. 53.8％，p  = 0.006）以及显着降低的血红蛋白水平（14.45±2.06 vs. 17.15±1.77，p  = 0.003）和钾（3.50±0.86 vs. 4.14±0.93，p  = 0.003）和中性粒细胞水平（3.34±1.75 vs. 4.47±1.08，p = 0.047，白细胞（WBC）（5.54±2.30对7.78±1.70，p  = 0.003）和血小板（中位[最小-最大] 133.5 [68-332]对196 [123-550]，p  = 0.006）计数。挛缩的存在（优势比[OR]：14.525，95％置信区间[CI]：1.398–150.870，p  = 0.025）和呼吸机支撑（OR：22.282，95％CI：1.269–391.131，p  = 0.034）是死亡风险增加的独立决定因素。

结论 我们的发现强调了索马里新生儿破伤风病例的高死亡率以及大多数病例缺乏母体破伤风的预防。挛缩和呼吸机支持的存在是不良生存的重要决定因素，而便秘，血红蛋白和钾水平降低以及中性粒细胞，WBC和血小板计数降低等因素在非幸存者中也更为常见，尽管未发现与死亡风险相关。多元分析。

出版历史

收到：2020年4月5日

接受：2020年8月12日

发布日期：
2020年9月21日（在线）

Georg Thieme Verlag KG
斯图加特·纽约