1. Tetanus neonatorum

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

3. 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

4. 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

5. 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

6. Lock – jaw

7. Opisthotonos

8. 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

9. 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

10. 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

11. 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