Some Stories are Yet Not Over: Experiences of Neonatal Tetanus from a Tertiary Care Hospital, Bangladesh

Neonatal tetanus (NT), also known as tetanus neonatorum is a highly fatal and a severe public health problem. The case fatality rate of NT without treatment is close to 100.0%. Objective of this study was to describe our experiences with NT from a tertiary care hospital, Bangladesh. This prospective observational study was conducted at the Neonatology ward, Mymensingh Medical College Hospital (MMCH), Bangladesh over a period of 3 years from August 2022 to July 2025. A total of 68 neonates admitted with tetanus in Neonatology ward, MMCH during the study period, who were included in the study to observe risk factors, clinical presentations, complications, treatment duration and outcomes during hospital stay. Among 68 neonates with tetanus, 75.0% were male and 77.0% were born as term according to their gestational age. 78.0% of mothers didn't receive any dose of tetanus toxoid (TT); 96.0% of the cases were delivered by vaginal route and umbilical cord cut and tied by unsterilized blade and thread in 66.0% cases; 52.0% of the cases were admitted within 8-14 days of age; 94.0% of cases were from rural area. Most frequently applied substances to the cord stump were dry jute leave (25.0%), hot soak (19.0%), shidur/vermillion (16.0%), mustard oil (13.0%), savlon (9.0%), turmeric (7.0%), boric acid powder (6.0%) etc. Common presentations of NT were stiffness or rigidity (100.0%), Inability or difficulty to breast feeding (97.0%), convulsion (88.0%), lock jaw (71.0%) and umbilical infection (62.0%). All the patients of this study were treated by Tetanus immunoglobulin (TIG), antibiotics and diazepam. Duration of hospital stay in majority of patients was 21-30 days. Most frequently observed complications were aspiration pneumonia (50.0%), septicemia (40.0%) and respiratory failure (21.0%). Case fatality rate was 43.0%. Risk factors observed in NT cases were maternal non-immunization, unhygienic delivery practices, application of unusual substances and social taboo in umbilical cord care. Strengthening of EPI vaccination, antenatal TT administration and proper delivery care including cord care is pivotal to prevent NT.