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