A Rare Survival of Neonatal Tetanus: A Case Report of Comprehensive Treatment and Positive outcome in a Referral Hospital in Nigeria

Background: Neonatal tetanus remains an important cause of avoidable morbidity and mortality in neonates, particularly in developing countries, including Nigeria. The case fatality rate of neonatal tetanus in resource-limited settings approaches 100%, but this can be reduced to less than 20% with increased antenatal vaccination coverage and implementing clean delivery practices. One case of neonatal tetanus represents more than an individual tragedy- it exposes critical shortcomings in public healthcare infrastructure and preventive care. Umbilical sepsis in neonates born to unvaccinated mothers significantly increases susceptibility to neonatal tetanus. Resource constraints in underdeveloped regions have significantly impeded the outcome of neonatal tetanus management. In this report, we described a critical case of neonatal tetanus in a neonate born to an unvaccinated mother. Case presentation: A 9-day-old term male of the Igbo ethnic group in Nigeria, Cheta baby, presented to our facility with high-grade fever, inability to breastfeed, and stiffening of the body triggered by touch or sound, which started on the seventh day of life. On admission, he had signs of respiratory distress, febrile, tachycardia, and multiple muscle spasms. A diagnosis of neonatal tetanus with autonomic dysfunction was made. The patient was commenced on a cocktail comprising rectal diazepam, intravenous phenobarbitone, intravenous chlorpromazine and magnesium sulfate infusion. He improved remarkably and was discharged after 34 days of in-patient care. Conclusion: This report aims to enhance paediatricians' recognition of neonatal tetanus symptoms for prompt diagnosis and treatment, while emphasizing the critical role of vaccination and clean birth practices in preventing this life-threatening condition.