Successful management of neonatal tetanus with autonomic manifestations at a referral hospital in Nigeria: a case report

Abstract

BACKGROUND: Neonatal tetanus remains a significant cause of preventable neonatal death in developing countries like Nigeria. With case fatality rates approaching 100% in resource-poor settings, improved antenatal tetanus vaccination and clean delivery practices can drastically reduce mortality. Each case of neonatal tetanus highlights major gaps in public health systems, especially where umbilical sepsis and maternal non-vaccination are common. This report presents a critical case of neonatal tetanus in an infant born to an unvaccinated mother managed successfully despite limited resources. CASE PRESENTATION: A 9-day-old term Igbo male presented with high-grade fever, feeding difficulty and intermittent body stiffening triggered by sound or touch, beginning on the seventh day of life. Examination revealed respiratory distress, fever, tachycardia, and multiple muscle spasms. Neonatal tetanus with autonomic dysfunction was diagnosed. He was treated with intravenous diazepam, phenobarbitone, chlorpromazine, and magnesium sulfate infusion. The patient showed marked improvement and was discharged after 34 days of hospitalization. CONCLUSION: This case underscores the importance of maternal tetanus immunization and clean delivery practices in preventing neonatal tetanus, while demonstrating that timely intervention can lead to favorable outcomes even in resource-limited settings.