Some Modifications in Method of Treating Tetanus Neonatorum with Intermittent Positive-pressure Respiration.

In a previous paper we showed that the treatment of severe tetanus neonatorum by means of total paralysis and intermittent positive-pressure respiration (I.P.P.R.) represents a real therapeutic advance (Wright, Sykes, Jackson, Mann and Adams, 1961), and this has since been confirmed in Cape Town by Smythe (1963). Mortality rates of over 80% on conservative treatment have been reduced by this technique to under 40 %. Experience with 100 infants with tetanus neonatorum admitted to our unit in a 12-month period shows that the majority (77 %) need respiratory assistance of some sort, judged by the occurrence of apnoeic and cyanotic attacks. Such numbers indicate not only the high incidence of this disease in Natal but also the size of the problem if all severe cases are to be treated by the full I.P.P.R. method. We admit all patients with tetanus to a special unit, staffed by two doctors, a nursing sister, 19 nurses, and a medical technologist. Seven respirators and ancillary equipment are available for treating acute respiratory failure. Elsewhere in Africa and in other parts of the world where tetanus is common, medical services are sometimes less well developed than they are in South Africa. We therefore felt justified in conducting further clinical trials in search of simpler or more economical methods. In this paper we report the results with two modifications of our standard method described by Mann, Jackson and Holloway (1963).