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新生兒破傷風 59 例의 臨床的觀察

Clinical Observation on Fifty-nine Cases of Tetanus Neonatorum

소아과 1969년 10권 7호 p.15 ~ 20
소속 상세정보
孫槿贊/Sohn, Keun Chan 方斗憲/李謹洙/Bang, Doo Hun/Lee, Keun Soo

Abstract


Tetanus in the newborn infant is still one of the most important health problem in Korea. From 1959 to 1966, fifty nine cases of neonatal tetanus were abserved and, among these patients, we have followed 57 cases until the recovery or death.
The over-all mortality rate was 56.1 per cent. The ratio of males to females was approximately 2 ordinary scissors. However, one case was delivered at home by a midwife, and two cases were born at the obstetric clinics. Because of low standard of economy, we cannot advocate that all the deliveries dhould be done at the hospital, but, at least, we can educate the people that the umbilical cord should be cut by sterile instruments.
The majority of infants were admitted on 5th to 8th day of life. The case fatality rate was above 55.6 per cent among infants admitted before 8 days of life, wheras no deaths occurred among infants admitted after the tenth day of life. In 61.4 per cent, the duration of symptoms before admission was less than 24 hours. The majority except 14 cases had relatively high fever on admission. In fatal cases, the 62.5 per cent of infants died within 72 hours after admission and over 90 per cent were expired within a week. The duration from onset of disease until death was less than 8 days in 87.5 per cent. In the recovered patients, the duration of hospitalization was 13 to 67 days.
In recent years there was shown downward tendency of yearly fatality rate. It was achieved by (1) intensive nursing care, (2) the appropriate sedation by phenobarbital and chlorpromazine, which prevents the prolonged ot apneic seizures, (3) less heavy dose of tetanus antitoxin-on the day admission, 10,000~15,000 units intramusculary and 5,000 units periumbilically, and then for the following 5 days, 5,000 units periumbilically, and (4) nutritional care using half whole milk by the gastric dripping method since soon after admission. Among these, the latter two methods could be stated to have acted very importantly.

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