Tetanus neonatorum (PowerPoint)

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					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 .
• 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
                   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
Lock – jaw
• 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
 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
• 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 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

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