| ID | 366 |
|---|---|
| Name | TETANUS NEONATORUM |
| Cause | Nonsterile instruments are used to cut the umbilical cord or when contaminated material is used to cover the umbilical stump. Deliveries carried out by people with unclean hands or on a contaminated surface are also risk factors |
| Signs Symptoms | Muscle spasms, which are often preceded by the newborn's inability to suck or breastfeed, and excessive crying |
| Diagnosis | Clinical Evaluation |
| Investigations | |
| Management | Management: A. Specific treatment- 1. Tetanus immunoglobulin (TIG) of human origin: TIG neutralizes the circulating tetanus toxin, but it has no role in dislodging the toxin already fixed to the nerve roots. Therefore, TIG should be given as soon as possible in order to neutralize toxin that diffuses from the wound into the circulation before the toxin can bind at distant muscle groups. A single dose of 500 unites of TIG (human origin) i.m injection is sufficient to meutralize systemic tetanus toxin, but total doses as high as 3,000-6,000 units are also recommended. If TIG is not available, an alternative tetanus antitoxin of equine or bovine origin (TAT or ATS injection, 10,000 units/5ml vial) can be given. The usual total dose is 50,000-100,000 units, which is administered half the dose i.m and half i.v; but, as little as 10,000 units may be sufficient. Tetanus antitoxin (TAT or ATS injection) should also be given as soon as possible before the tetanus toxin gets fixed to the neural tissue. 2. Penicillin G 100,000 units/kg/day i.v in 4-6 hourly divided doses for 10-14 days (to eradicate vegetative Cl tetani). In case of penicillin sensitivity, erythromycin may be given as an alternativeMetronidazole can be given. 3. Diazepam (in controlling hypertonicity & spasm) 0.2mg/kg/dose every 3-6 hr. i.v or i.m (it is the authors’ experience that higher dose, 5mg/kg or more is needed for controlling seizures). Chlorpromazine 2mg/kg/day in 3 divided doses may be used. Total 2-6 wk of therapy may be required. Magnesium Sulfate is also can be given 4. Neuromuscular blocking agents, such as d-tubocurarine and more recently pancuronium bromide or Atracurium Bromide can be used i.v to control seizure, specially where . facilities for artificial ventilation is available. B. Supportive treatment- 1. Meticulous nursing care. 2. Minimum handling. 3. Patient should be placed isolated in a dark, calm & quiet room. 4. A respirator, O2, suction apparatus & equipment for tracheostomy should be available. 5. Nutrition- N.G tube feeding or i.v alimentation may be given- an adequate intake of fluid, electrolytes & calories should be maintained 6. Wound should be cleansed & debribed if necessary; foreign bodies must be removed, & the wound left opened. C. Treatment of complications- such as, aspiration pnenmomia, respiratory obstruction, laceration of tougue, vertebral fractures (in severe tetanic seizures) peripheral neuropathy etc. Prophylaxis of neonatal tetanus:1337 A. Active immunization of pregnant mother & infants: See immunization schedule. B. Tetanus prophylaxis following injury: Immediate & thorough surgical treatment of all wounds with antiseptic wash or toileting must be done. Then, the prophylactic measures should be taken according to immunity category of the patients- 1. Wounds that are less than 6 hours old, clean, non-penetrating and with negligible tissue damage- Immunity category Prophylactic measure a. Patient has had a a. Nothing more complete required. course of toxoid (3 doses) or a booster dose within the past 5 years, b. Patient has had a complete b. Tetanus toxoid 1 course of toxoid or a booster dose, dose of more than 5 years & less than 10 years ago. c. Patient has had a complete c. Tetanus toxoid 1 course of toxoid or a booster dose. dose of more than 10 years ago. d. Patient has not had a d. Tetanus toxoid complete course of toxoid complete course (3 and no booster dose. doses). 2. Other wounds- such as, wounds contaminated with dirt, feces, and saliva; puncture wounds; avulsions; wounds, resulting from missiles, crushing, burns and frostbite; and wounds extending into muscle etc- Immunity category Prophylactic measure a. Patient has had a complete a. Nothing more course of toxoid (3 doses) or required. a booster dose within the past 5 years, b. Patient has had a complete b. Tetanus toxoid 1 course of toxoid or a booster dose. dose of more than 5 years & less than 10 years ago. c. Patient has had a complete c. Tetanus toxoid 1 course of toxoid or a booster dose dose of more than 10 years + human tetanus ago.immunoglobulin (TIG), d. Patient has not had a d. Tetanus toxoid complete course of toxoid complete course (3 and no booster dose. doses) + human tetanus immunoglobulin (TIG). 3. Recovery from tetanus does not confer immunity; therefore, active immunization of the patient following recovery is imperative. |
| Introduction | Tetanus neonatorum or neonatal tetanus is the infantile form of generalized tetanus, usually manifests within 3-12 days of birth. It is one of the top five causes of neonatal mortality in our country, & also other tropical countries, where the umbilical cord may be cut with a dirty knife, spear or piece of broken glass, may be tied with a dirty cloth or thread, or dressed with animal dung. |
| History | |
| Etiology | See under cause |
| Clinical Features | Clinical features: 1. Onset with progressive difficulty in feeding (sucking and swallowing) associated hunger and crying. Difficulty in sucking is due to masseteric spasms followed by- 2. Tetanic spasms which result in risus sardonicus & opisthotonus. 3. Between the spasms, there is continueous muscle rigidity with clenched jaw, risus sardonicus & stiff back, neck, abdominal wall & limbs. 4. Death caflt occur from arrest of breathing during a spasm or from intercurrent pneumonia. |
| Preventions | Maternal immunization is recommended with two doses of tetanus toxoid 4 weeks apart during pregnanc |
| Treatment | Stop toxin production at the infection site along with wound care. The concurrent step is to use antibiotics along with immunoglobins that can cancel out circulating |
| Complications | Breathing problems. Life-threatening breathing problems can occur from tightening of the vocal cords and muscle rigidity in the neck and abdomen, especially during a generalized spasm. Blockage of a lung artery (pulmonary embolism). ... Pneumonia. ... Broken bones. ... Death. |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology |
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