General Seminar Neonatal Tetanus 2 1

Neonatal Tetanus
PRESENTED BY DR ANANTHA KRISHNAN VK

GUIDED BY DR CHANDHRAKANTH
–INTRODUCTION–
 Tetanus is a non-communicable bacterial disease caused by the

neurotoxin tetanospasmin elaborated by Clostridium tetani,
and characterized by a prolonged contraction of skeletal muscle
fibers causing sustained muscular spasm and convulsions.
 Causes: Contaminated wounds, Iacerations, injection sites,
abrasions, burns, frostbites, surgeries and unhygienic child
births
–Types of Tetanus–
 Generalized Tetanus – Affect all skeletal muscles

most common and sever
 Local Tetanus – Manifest with muscle spasm at or near the wound
May progress to generalized Tetanus
 Cephalic Tetanus – affect rapidly in muscles of face causes like:
head injury or ear infection , dental
extraction
Trismus mays occur
 Neonatal Tetanus – Similar to generalized
except that it affects neonate
–Definition–
 WHO definition of a confirmed neonatal tetanus case
is an illness occurring in an infant who has the normal
ability to suck and cry in the first 2 days of life, but
who loses this ability between days 3 and 28 of life
and becomes rigid or has spasms
• It usually occurs through infection of

the unhealed umbilical stump,
particularly when the stump is cut
with an unsterile instrument.
–Pathogenesis–
The spores of the Transformation When

organism remain non occurs in the transformed it
pathogenic in soil or presence of locally produces
contaminated tissues decreased oxygen
until conditions are Tetanospasmin
reduction potential
favorable for
transformation into
vegetative form.
 TetanospasminBinds to NM  In normal states these
junction at the site of injury neurotransmitters prevent
and undergoes retrograde release of Ach from excitatory
axonal transport to reach neurons thus prevent muscle
presynaptic nerve terminal contraction in the presence of
where it prevents the inhibitory toxins these inhibitory
neurotransmitters GLYCINE impulses are prevented
AND GABA leading to uncontrolled
contraction of muscles
–Transmission and communicability–
• Highly infectious but not • Incubation period: 3-21
communicable disease days (range 0->60 days)
 Neonatal tetanus:
 Maternal tetanus:
 1. Unclean instrument to
 1. unclean delivery/abortion
cut the umbilical cord
 2. poor post natal hygiene  2. Umbilical stump covered
with contaminated material
–Clinical Features–
Usually symptoms begins 3-10 days after birth and
pattern is generalized.
Initial symptom is failure to suck and inability to
open the mouth known as trismus or lockjaw.
 Spasm of the facial muscles immobilize the jaw
and produces a fixed sardonic grin called risus
sardonicus
 Generalized tonic muscular convulsions occur
producing flexion & adduction of the arms,
clenching of fists & extension of the lower
extremities.Initially spasms are mild but later
become severe with spasms of the glottis &
respiratory muscles.
Abdominal muscles become rigid and spasms of the
muscles of the back may result in opisthotonus.
Spasms may be precipitated by touch, noise or bright
light.
 Baby remains conscious and allert.
• Characteristic features: -
1. Spasm of facial muscles - Trismus and Risus
sardonicus
2. Spasm of back muscles - Ophisthotonous
3. Generalised tonic seizures - Tetanospasms
4. Spasm of glottis - sudden death.
–Management–
 1. Isolate the baby in dark silent room.

 2. Clean the umbilicus/wound.
 3. Frequent change of posture
 4. Continuous monitoring of vitals
 5. NG feed
 6. Sedation by i.v. Diazepam, Phenobarbitone,
Paraldehyde
 7. Antibiotics of choice: - Intravenous Penicillin and
Metronidazole
Aims of treatment are:
■Remove the source of exotoxin
■ Neutralize the remaining circulating

toxins
■ Provide supportive care until toxin is

metabolized.
–Specific measures–
■Washing and debridment of the infected site,and

administeration of antibiotics such as Benzyl penicillin or
Metronidazole.
■ Anti-toxin
1)Anti-tetanus serum –(50,000-100,000 U)
2)Human tetanus immunoglobulin (3000- 6000 u)

–Supportive measures–
Sedation by-
1)Diazepam (0.1-0.2 mg/kg)
2)Phenobarbitone
3)Paraldehyde
Nursing care: Feeding by:
■Clean the umbilicus/wound ■NG tube
■ Daily milk requirement
is 100- 120 ml/kg/day.
■ Isolate the baby in dark
silent room
■Change the posture
■Cardiorespiratory
monitoring
–Differential Diagnosis–
1. Sepsis
2. Meningitis
3. Neonatal seizure
4. Hypoxic Ischemic Encephalopathy
5. Rabies: - hydrophobia, mainly clonic seizures
6. Hypocalcaemia: - no lockjaw
7. Strychnine poisoning: - no lockjaw,generalised relaxation
b/w spasms
–PROGNOSIS –
The prognosis in neonatal tetanus is worse if
1.Onset of symptoms occurs within 1 week of life
2.interval between lockjaw on onset of spasms

is less than 48
3.High fever and tachycardia are present
4.Spasms, especially of larynx resulting in apnea

and are very severe and frequent.
 Good prognostic factors
 Incubation period more than 8-10 days.
 Progression longer than 60 hrs.
 Absence of fever.
 Local disease.
 Survival for 10 days.
–Complications–
 Aspiration pneumonia
 Lacerations of mouth & tongue
 Intramuscular hematomas or rhabdomyolysis leading to
hemoglobinuria & renal failure.
 Vertebral fractures.
 Decubitus ulcerations.
 Autonomic disturbances.
–Prevention–
 Immunize the mother during pregnancy
 5 Clean in delivery:
Clean hands of the attendant
Clean surface
Clean blade
Clean cord tie
Clean cloth to wrap the mother
 Training of Dais
 Immunize the baby after the recovery from disease:
1st dose of vaccine is given
VACCINATION after 6 weeks of recovery.
SCHEDULE
TT-1 During the first pregnancy
TT-2 1 month after the first dose
TT-3 6 month after the second
dose
TT-4 1 year after the third dose
 In May 2015, India has achieved another
significant public health milestone of
maternal and neonatal tetanus elimination
 In India, there was a significant decline in
the number of reported NT cases from
almost 80,000 in 1980 to
fewer than 500 cases in

2013.
 According to the World Health Organization
(WHO) elimination of NT is defined as an
incidence of less than one case of NT in
1000 live births in every district or similar
administrative unit across the nation in a
Expanded Programme of Immunization was launched
by Government of India (GOI) in 1977 with BCG,
OPV, and DPT with a target of 80% coverage in
infancy. This program on immunization was
relaunched as the Universal Immunization
Programme in 1985 with major change.
 In 2005, the National Rural Health Mission was
launched which pushed up institutional deliveries
through "Janani Suraksha Yojana" and also
trained many traditional birth attendants for safe
deliveries.
 Mission "Indradhanush" was launched by GOI in
2014 to cover children who are either partially
vaccinated or unvaccinated against seven vaccine
preventable diseases which include tetanus. These
efforts paid the result
Reference
 CARE of the NEWBORN Seventh Edition ByMeharban Singh

 The Short Textbook of PEDIATRICS by Suraj Gupte
 HUTCHISON'SPAEDIATRICS by HKrishna M Goel And Devendra K Gupta
 Pubmed https://pubmed.ncbi.nlm.nih.gov/6386211/
 World Health Organization. Maternal and Neonatal Tetanus (MNT)
Elimination- http://www.who.int/immunization/diseases/MNTE initiative/en/
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Neonatal Tetanus

PRESENTED BY DR ANANTHA KRISHNAN VK

 Tetanus is a non-communicable bacterial disease caused by the

 Generalized Tetanus – Affect all skeletal muscles

• It usually occurs through infection of

The spores of the Transformation When

 1. Isolate the baby in dark silent room.

■Remove the source of exotoxin

■ Neutralize the remaining circulating

■ Provide supportive care until toxin is

■Washing and debridment of the infected site,and

1)Anti-tetanus serum –(50,000-100,000 U)

2)Human tetanus immunoglobulin (3000- 6000 u)

1)Diazepam (0.1-0.2 mg/kg)

■Change the posture

1.Onset of symptoms occurs within 1 week of life

2.interval between lockjaw on onset of spasms

3.High fever and tachycardia are present

4.Spasms, especially of larynx resulting in apnea

almost 80,000 in 1980 to

fewer than 500 cases in

 CARE of the NEWBORN Seventh Edition ByMeharban Singh

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