Assisted respiration in the treatment of neonatal tetanus.

Conservative management of severe tetanus neonatorum is attended by a very high mortality (Tompkins, 1958; Wright, 1960a; Adams, Holloway, and Thambiran, 1964). Tracheostomy in addition to sedation has not been successful in preventing respiratory failure, which necessitated mechanical ventilation (IPPV) in about 90% of the patients described by Holloway (1967). Although IPPV has been shown to be the treatment of choice in this disease (Wright et al., 1961; Smythe, 1963), this technique requires a team of medical personnel and an efficient nursing staff to cope with the special hazards introduced by the use of mechanical apparatus and the practice of tracheostomy. These facilities are not readily available in countries where tetanus occurs frequently, and modifications of IPPV would be of value in these areas. This paper reports on a clinical trial which compares the management of severe tetanus neonatorum by two techniques: (a) tracheostomy, total paralysis, and IPPV; (b) tracheostomy, sedation, and assisted respiration. Assisted respiration is defined as IPPV without total paralysis, using chlorpromazine and phenobarbitone to control reflex spasms (Adams et al., 1964).