Tetanus neonatorum

Tetanus neonatorumImportant 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 extensionSpasm 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 oxygenNursed in a quite roomI.M injections must be avoidedOropharyngeal 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