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 non-
encapsulated , 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 and 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
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