Tetanus neonatorum Tetanus neonatorum Important cause of newborn

Tetanus neonatorum

Tetanus neonatorum • Important cause of newborn deaths a few decade back • Universal tetanus toxoid vaccination of mother has led to eradication of this disease.

Etiopathogenesis • Caused by : Gm positive motile nonencapsulated , anaerobic , spore bearing bacillus ------ Clostridium tetani • Open wound ----- body ----- produce tetanospasmin ( powerful neurotoxin )------ toxin enters the circulation------ carried to motor end plate ------- interfering with neurotransmitter release and blocking inhibitor impulses lead to uncontrollable muscle contractions

Clinical features • Start by 5 to 10 days after birth Initial symptoms : – Excessive unexplained crying – Refusal of feeding and – Apathy – Mouth is slightly open ( due to spasm of the neck ) – Dysphagia and choking ( pharyngeal muscle spasm ) – Constipation persists until the spasm are relieved

Cont … • Lock – jaw followed by spasm of limbs • Generalised rigidity and opisthotonos ( rigid spasm of the body with the back fully arched and the heels and head bent back ) in extension • Spasm of larynx and respiratory muscles characteristically induced by stimuli of touch , noise and bright light in episodes of apnea and cyanosis

Lock – jaw

Opisthotonos

Management • Active immunization of the pregnant women with two injections of T. T given at monthly intervals during the pregnancy • Public health education while cutting the umbilical cord at home delivery Good supportive measures : • Maintenance of oxygen • Nursed in a quite room • I. M injections must be avoided • Oropharyngeal secretion should be cleared periodically

Cont… Nutrition, fluid and electrolytes : • Oral feeding should be stopped an I. V line should be established for providing adequate fluids , calories and electrolytes and for administration of various drugs • After 3 to 4 days of Tx. , milk feeding through NG tube may be started Antibiotic : penicilin or cephalosporin

Cont. . Tetanus anti – toxin : ---- Neutrlizes the circulating toxins , but it cannot dislodge the toxin already fixed to the nerve roots ---- Recovery of nerve function from tetanus toxins requires sprouting of new nerve terminals and formation of new synapses. • Dose : 500 U Tracheostomy and assisted ventilation : • If the infant gets frequent episodes of laryngeal spasm , apneic attacks with cyanosis or respiratory failure. Control of spasm : • Diazepam : I. V , 0. 5 – 5 mg / kg every 2 – 4 hours

Prognosis is worse : • Onset of symptoms occurs within the first weeks of life • Interval between lock – jaw on onset of spasm is less than 48 hours • High fever and tachycardia • Spasm especially of larynx resulting in apnea