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新生兒 破傷風의 臨床 및 豫防에 關한 觀察

A Clinical Study and Preventive Program of Neonatal Tetanus

고려대학교의과대학잡지 1979년 16권 3호 p.543 ~ 550
吳東鮮, 李鉉金,
소속 상세정보
吳東鮮 (  ) - 高麗大學校醫科大學 小兒科學敎室
李鉉金 (  ) - 高麗大學校醫科大學 小兒科學敎室

Abstract


Although recent remarkable development of economic condition and improvement of living standard neonatal tetanus is still one of the serious problems in Korea, because of its relatively high incidence and mortality rate even with high skills and modern medicine.
Prevention is the most important regimen so far. Author observed clinically total 28 cases of neonatal tetanus who were admitted to the Department of Pediatrics, Korea University Hospital from January 1974 to September 1978, at the same time, evaluated the effect of preventive program in a rural underprivileged area where deliveries usually performed in the homes by self-deliveries or by traditional birth attendants through the observation on the 22 cases of newly born infants.
Preventive program against neonatal tetanus were carried out on the base of education and equipment supply.
Equipment supplied were simplest one autoclaving envelop containing an old mess blade
(changed to small scissors later), a length of ligature and dressing. Education on care of
the umbilical cord was undertaken for traditional birth attendants and mother and they
were taught to use the equipment for cutting the cord and a sterile dressing. The following results were obtained.
1. The incidence of neonatal tetanus has not decreased during past 4 years and 9 months period annual admission was 6 cases as mean.
2. Sex incidence showed that male predominated in a ratio of 4.6:1.
3. The majority of patients (85.7%) were 4 to 7 days of age on admission and peak incidence was noted at the age of 6 days (32. 1%).
4. The most of the infants (92.8%) has had between 2,5109m to 4, 000gm of body weight on admission and there was no evidence of higher incidence in low birth weight infant than others.
5. One third of the patients were lived in rural area and 2/3 were in urban. Twenty three of 28 patients (82.290´) were delivered " at - home; and 5 cases (17.8%) were at private clinics.
6. Many of them (71.41061) were used unsterilized home scissors to cut the umbilical cord, although boiled scissors or instruments were used in 6 cases.
7. The typical symptoms such as sucking failure (75.00), convulsion (60.7%), irritability, trismus and fever were observed in most of the patients.
8. The majority of patients (64.3016) were stayed in hospital between 2 to 5 days and discharged to home against advice. Half of them were signed out on admission day or 2nd hospital day and all of them within 5th hospital day. Four cases who were stayed in hospital more than 20 days were all recovered completely and 3 cases were died within 8th hospital day.
9. Preventive program against neonatal tetanus in the rural underprivileged area by both the education and supply of simplest equipment for cutting the cord have been shown to be effective. During the period of this program, there were 22 cases of deliveries and no one had neonatal tetanus.
First physical examination after birth showed only minor medical problems such as umbilical discharge, mild jaundice, thrush, loose stool, URI, skin and eye infections.

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