Tetanus in children: an 11-year review

One hundred and three cases of tetanus in children 1-12 years of age were reviewed. Sixty-six per cent had severe disease, half of whom required management with total muscle paralysis and intermittent positive pressure ventilation (IPPV), and 70% in this group developed signs of sympathetic overactivity (SOA). Control of SOA with morphia 0.5-1 mg/kg/dose given 1-4 times a day appears to have decreased the mortality rate from this complication of severe tetanus. There was a relative resistance to drug control of SOA in the youngest children. High output renal failure developed in two children, an incidence much the same as reported in severely affected adults. The overall mortality rate of this series was 14.5%: all the deaths were amongst those severely affected. The cause of death could be attributed to tetanus in half, while in the remainder it resulted from complications of intensive therapy. Tetanus in children resembles the disease in adults.