Brain damage after neonatal tetanus in a rural Kenyan hospital

Abstract

OBJECTIVE: Neonatal tetanus (NNT) is an important cause of mortality in resource poor countries, particularly sub-Saharan Africa. There are no reports of the long-term outcome of children who survive NUT in African hospitals. DESIGN: In a retrospective study of children discharged from Kilifi District Hospital (KDH), Kenya with NNT, each child was linked with a comparative child (CC) in the community matched for age, sex and locality. PARTICIPANTS: A total of 123 patients were admitted with NUT between 1992 and 1996, of whom 68% died. Twenty-three (59%) of the 39 survivors were traced in the community, 10 had moved away, six had died. OUTCOME MEASURES: NNT survivors underwent a neurological and developmental examination and a questionnaire was administered to the parents about the behaviour of the child. A verbal autopsy was used to determine the cause of death in children who had died after discharge. RESULTS: The head circumference of NUT survivors was significantly smaller than that of CC (P = 0.037); eight children had microcephaly compared with one CC (P = 0.011). NUT survivors had more problems with hand-eye co-ordination tasks (P = 0.035), a lower summated developmental score (P = 0.023) and more mild neurological abnormalities (P = 0.008) than CC. Parents of NUT survivors reported more behavioural problems (P = 0.02) than parents of CC. CONCLUSIONS: Children who survive NUT have evidence of brain damage that manifests as microcephaly, mild neurological abnormalities, developmental impairment - particularly fine motor difficulties - and behaviour problems.