Thursday, July 13, 2017

Papers 2017

Intrathechal vs. Intramuscular Human Tetanus Immunoglobulin in Pediatric Tetanus: A Retrospective Study


Objective          To evaluate the effect of intrathecal vs. intramuscular tetanus immunoglobulin therapy on hospital stay and mortality in pediatric tetanus patients admitted to a tertiary care hospital.
Methods             Retrospective analysis of hospital records of tetanus cases to the pediatric ward during two year period from  march  2012 to february  2014 was done. All patients were managed as per pre-existing unit protocol. Group A received Human tetanus immunoglobulin (TIG) 250 unit via the Intrathecal route preceded by IV ketamine (1 mg/kg) for proper relaxation to ease the procedure and the group B was given TIG 750 unit via intramuscular route. Whether to give TIG by Intrathecal or intramuscular route was decided according to the treating unit’s protocol. Information regarding– sex, age, immunization status, mode of infection, grade of tetanus, outcome and hospital stay was recorded in the two groups.
Results              After excluding Neonatal tetanus cases there were 40 patients aged between 1 to 12 years during the two year study period. Out of 40, group A had 15 patients (intrathecal route) and group B had 25 (intramuscular route). Mortality and hospital stay was found to be numerically less, but statistically not significant, in group A (26.67%; 12.4 ±2.25days) as compared to group B (28%:15.4 ± 1.69 days).
Conclusion       We found no significant difference between intrathecal immunoglobulin and intramuscular immunoglobulin therapy in management of pediatric tetanus in terms of mortality and hospital stay. An unintended result was that ketamine can be safely used as a sedative in tetanus patients for lumbar puncture to give intrathecal antitetanus immunoglobulin.  

http://rfppl.co.in/online_first.php?jid=22
Pediatric Education Research 2017:5(2):57-60.

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