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. 2017 Sep 25;17(1):646.
doi: 10.1186/s12879-017-2748-3.

Long-term outcome in survivors of neonatal tetanus following specialist intensive care in Vietnam

Huynh T Trieu  1 , Nguyen Thi Kim Anh  2 , Huynh Ngoc Thien Vuong  3 , T T M Dao  2 , Nguyen Thi Xuan Hoa  2 , Vo Ngoc Cat Tuong  2 , Pham Tam Dinh  2 , Bridget Wills  2   4 , Phan Tu Qui  3   2 , Le Van Tan  2 , Lam Minh Yen  2 , Saraswathy Sabanathan  2 , Catherine Louise Thwaites  2   4
Affiliations

Long-term outcome in survivors of neonatal tetanus following specialist intensive care in Vietnam

Huynh T Trieu et al. BMC Infect Dis. .

Abstract

Background: Neonatal tetanus continues to occur in many resource-limited settings but there are few data regarding long-term neurological outcome from the disease, especially in settings with critical care facilities.

Methods: We assessed long-term outcome following neonatal tetanus in infants treated in a pediatric intensive care unit in southern Vietnam. Neurological and neurodevelopmental testing was performed in 17 survivors of neonatal tetanus and 18 control children from the same communities using tools previously validated in Vietnamese children.

Results: The median age of children assessed was 36 months. Eight neonatal tetanus survivors and 9 community control cases aged < 42 months were tested using the Bayley III Scales of Infant and Toddler Development (Bayley III-VN) and 8 neonatal tetanus survivors and 9 community controls aged ≥42 months were tested using the Movement Assessment Battery for Children. No significant reductions in growth indices or neurodevelopmental scores were shown in survivors of neonatal tetanus compared to controls although there was a trend towards lower scores in neonatal tetanus survivors. Neurological examination was normal in all children except for two neonatal tetanus survivors with perceptive deafness and one child with mild gross motor abnormality. Neonatal tetanus survivors who had expienced severe disease (Ablett grade ≥ 3) had lower total Bayley III-VN scores than those with mild disease (15 (IQR 14-18) vs 24 (IQR 19-27), p = 0.05) with a significantly lower cognitive domain score (3 (IQR 2-6) severe disease vs 7 (IQR 7-8) mild disease, p = 0.02).

Conclusions: Neonatal tetanus is associated with long-term sequelae in those with severe disease. In view of these findings, prevention of neonatal tetanus should remain a priority.

Keywords: Development; Neonatal tetanus; Outcome.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Hospital for Tropical Diseases Ethics Committee (Number CS/ND/15/28). Parents of participants signed informed consent forms before participating in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Assessment using Bayley III-VN Scales of Infant and Toddler Development: total scores (summated cognitive, fine motor and gross motor) and individual components for neonatal tetanus survivors (cases) and controls
Fig. 2
Fig. 2
Movement Assessment Battery for Children scores of cases neonatal tetanus survivors (cases) and controls showing total score (MABC: summated manual dexterity, aiming catching and balance) and individual components
Fig. 3
Fig. 3
Total (summated cognitive, fine motor and gross motor) Bayley III-VN Scores and individual domain components for cases by severity of disease
Fig. 4
Fig. 4
Total (summated manual dexterity, aiming catching and balance) Movement Assessment Battery for Children scores and individual domain components for cases by severity of disease
See this image and copyright information in PMC

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