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    General Seminar Neonatal Tetanus 2 1

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    General Seminar Neonatal Tetanus 2 1

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    General Seminar Neonatal Tetanus 2 1

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    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/
    Thank You

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