title: Prognosis of neonatal tetanus in the modern management era: an observational study in 107 Vietnamese infants.
abstract: OBJECTIVE
  Most data regarding the prognosis in neonatal tetanus originate from regions where limited resources have historically impeded management. It is not known whether recent improvements in critical care facilities in many low- and middle-income countries have affected indicators of a poor prognosis in neonatal tetanus. We aimed to determine the factors associated with worse outcomes in a Vietnamese hospital with neonatal intensive care facilities.
  
  
  METHODS
  Data were collected from 107 cases of neonatal tetanus. Clinical features on admission were analyzed against mortality and a combined endpoint of 'death or prolonged hospital stay'.
  
  
  RESULTS
  Multivariable analysis showed that only younger age (odds ratio (OR) for mortality 0.69, 95% confidence interval (CI) 0.48-0.98) and lower weight (OR for mortality 0.06, 95% CI 0.01-0.54) were significantly associated with both the combined endpoint and death. A shorter period of onset (OR 0.94, 95% CI 0.88-0.99), raised white cell count (OR 1.17, 95% CI 1.02-1.35), and time between first symptom and admission (OR 3.77, 95% CI 1.14-12.51) were also indicators of mortality.
  
  
  CONCLUSIONS
  Risk factors for a poor outcome in neonatal tetanus in a setting with critical care facilities include younger age, lower weight, delay in admission, and leukocytosis.
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam.
authors.forename: Phung Khanh
authors.initials: PK
authors.lastname: Lam
authors.affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Huynh T
authors.initials: HT
authors.lastname: Trieu
authors.affiliation: Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; University of North Sumatera, Medan, Indonesia.
authors.forename: Inke Nadia D
authors.initials: IN
authors.lastname: Lubis
authors.affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Huynh T
authors.initials: HT
authors.lastname: Loan
authors.affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Tran Thi Diem
authors.initials: TT
authors.lastname: Thuy
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Bridget
authors.initials: B
authors.lastname: Wills
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam; Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Parry
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Phan T
authors.initials: PT
authors.lastname: Qui
authors.affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
authors.forename: Lam Minh
authors.initials: LM
authors.lastname: Yen
authors.affiliation: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. Electronic address: lthwaites@oucru.org.
authors.forename: C Louise
authors.initials: CL
authors.lastname: Thwaites
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D013742:Tetanus / Q000175:diagnosis / Q000401:mortality*; D014744:Vietnam
keywords: Management; Neonatal tetanus; Outcome; Prognosis