All issues > Volume 17(1); 1974

Original Article

J Korean Pediatr Soc. 1974;17(1):52-62. Published online January 31, 1974.

Studies on the Effect of Sedatives and Muscle Relaxants in the Management of Tetanus Neonatrum

Kook Choo Rie¹, Hyesook Chang¹, Chong Koo Yun¹

¹Department of Pediatric, College of Medicine, Seoul National University Seoul, Korea

Abstract

Tetanus neonatrum is the serious disease because of its high mortality rate although there has been a gradual drop in mortality rate as a result of the use of antibiotics, intravenous feedings and improved nursing care. The control and prevention of seizure in the tetanus neonatrum has been of the most important and vexing problems. Hitherto, anticonvulsants, sedatives, or muscle relaxants employed to control the seizure or muscle spasm have been of only incomplete benifit and have introduced some add- itional hazards. Deep sedation may keep the patient in the perpetual coma state, even in. the lethal depression of respiration. Ere penicillin, neonatal tetanus was treated with TAT, sedatives or other general management but most of them died. Post penicillin, its mortality rate dropped significantly although improvement of technique on intravenons feedings and nursing care have been of the important factors. Hitherto, various sedatives or muscle relaxants have been employed to the treatment of neonatal tetanus but the mortality rate has been unaffected significantly although that drugs are of some value in relieving tonic spasm or convulsion. So we started the following tiral to evaluate the effect of sedatives and muscle relaxants in the management of tetanus neonatrum since 1971. 29 cases of neonatal tetanus admitted to the dep..of pediatrics SNUH from Jannary 1971 to August 1973 were allocated into one of three treatment , groups designated as sedation group, mild sedation group and non sedation group. Among them, 15 cases belong to the sedation group, 7 cases belong to the mild sedation group. :In sedation group, phenobarbital, chlorpromazine, meprobamate, chloral hydrate etc were used in full dosage and various combination. In mild sedation group, luminal or chloral hydrate or meprobamate were given from one to seven times during the hospitalization. All three groups were managed with TAT, penicillin injection, intravenous feeding and other general nursing care. The results were as follows: 1. 12 out of total 29 cases were dead and total mortality rate was 42%. In sedation group, 6 out of 15 cases were dead and the mortality rate was 40%. In mild sedation group, 3 out of 7 cases were dead and in non sedation group, 3 out of 7 cases were dead. Therefore these mortality rates are almost same with those of sedation group. 2. Average incubation periods of three groups were 5〜6 days. In incubation period, no significant differences in three groups were shown. 3. Prognosis of three groups were assessed in comparision with the incubation period, duration of symptoms before admission, duration of ospitalization in survival and expired case and duration, from admission to sucking. No significant differances in tree groups were obtained. Reviewing the result of our study, any kinds of sedatives and muscle relaxnts had no definite effect to the mortality rate of neonatal tetanus. Therefore, authors think that it is time to reconsider using these drugs routinely in the management of neonatal tetanus.

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