A detailed explanation on Tetanus Neonatorum.

1. Presented By:
M. SHARMIN BANDELI
Guided By:
Dr. PREETI MAM
NEONATAL
TETANUS
N.K.J. AYURVEDIC
MEDICAL COLLEGE,
BIDAR.

2. INTRODUCTION:
• Tetanos- a Greek word- “To stretch”.
• First described by Hippocrates and Sushruta.
• Tetanus is an Neurological disease.
• It can be prevented through vaccine.
• It is infectious but not contagious.
• It is characterized by acute onset of hypertonia, painful muscular
contractions and generalised muscle spasms without other apparent
medical causes.
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3. CAUSATIVE AGENT:
• Caused by Clostridiumtetani.
• Anaerobic.
• Motile
• Gram positive bacilli
• Oval, colourless
• Found worldwide
• Found in soil, inanimate environment, in animal faeces and occasionally
human faeces.
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4. CAUSATIVE FACTORS:
• Hand washing.
• Delivery practices.
• Traditional birth customs.
• Interest in immunization.
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5. EPIDEMIOLOGY:
• Tetanus is an International health problem.
• It is more common in damp, hot climates in developing and under
developing countries with soil rich in organic matter.
• More prevalent in industrial establishment where the agricultural workers
are employed.
• In India, it is an endemic infection.
• It’s prevalence is still a major concern in Karnataka.
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6. TRANSMISSION:
 Tetanus is not transmitted from person to person.
 Infection occurs when C.tetani spores are introduced into acute wounds
from trauma, surgeries and injections or chronic skin lesions and
infections.
 Most cases are resulted from the wounds that are too trivial to warrant
medical attention.
 Incubation period-
o Usually between 3 to 21 days
o Median- 7 days
o Shorter period- <7 days
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7. HOST FACTORS:
• Age: It is a disease of active age (5-40 yrs)
∶ New born baby
∶ Females during delivery or abortion.
• Sex: Higher incidence in males than in females.
• Occupation: Agricultural workers are at higher risks.
• Rural: > Urban areas.
• Immunity: Herd immunity doesn’t protect the individual.
• Environmental and social factors: Unhygienic custom habits, unhygienic
delivery practices.
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8. ROUTE OF ENTRY:
• Apparently trivial injuries.
• Animal/human bites.
• Open fractures.
• Burns.
• Gangrene.
• Abscess.
• Parenteral drug abuse.
• In neonates, usually via infected umbilical stumps.
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9. TETANUS PRONE WOUND:
• Wound sustained more than 6hrs before surgical treatment.
• Can persist in normal tissue for months to years in anaerobic conditions.
• When the oxygen levels surrounding the tissue is sufficiently low, the
implanted C. Tetani spore germinate into new, active vegetative cell that
grows and multiplies. And they also produces toxins- Teanolysin and
Tetanospasmin.
• Tetanolysin- Has no any clinical significance in tetanus.
• Tetanospasmin- Neurotoxin; Causes clinical manifestation of tetanus.
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10. 10
C. Tetani enters body through wounds.
Stays in sporulated form until anaerobic conditions are
presented.
Germinates under anaerobic conditions, multiply and
produces Tetanospasmin.
Tetanospasmin spreads through blood and lymphatic
systems.
Binds motor neurons.
Travel along axons to spinal cord.
Binds to sites responsible for inhibiting skeletal muscle
contractions.

11. TYPES OF TETANUS:
1. Generalized Tetanus- Most common and severe; Affects all skeletal
muscles.
2. Local Tetanus- Manifest with muscle spasms at or near the infected area.
3. Cephalic Tetanus- Affects the facial muscles after a head injury or ear
infection; lock jaw; easily progress to generalized tetanus.
4. Neonatal Tetanus- Similar to generalized tetanus but affects neonates.
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12. SYMPTOMS:
• Muscle rigidity.
• Irritability.
• Dysphagia.
• Restlessness.
• Facial grimacing.
• Muscle spasm.
• Poor suck.
• Usually symptoms begins 3-10 days after birth and pattern is generalized.
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13. 13
Lock Jaw
Dysphagia

14. 14
Opistotonus
Risus sardonicus

15. • Initial symptom is failure to suck and inability to open the mouth known
as Trismus or Lock Jaw.
• Spasm of the facial muscles immobilizes the jaw and produces a fixed
sardonic grin called Risussardonicus.
• Within 12-24 hours after the first symptom, generalized tonic muscular
convulsion occur producing flexion and adduction of the arms, clenching
of fists and extension of the lower extremities.
• Initially, spasms are mild but later become severe with spasms of glottis
and respiratory muscles.
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16. • Abdominal muscles become rigid and spasms of muscles of back region
may result in Opistotonus.
• Spasms may be precipitated by touch, noise or bright light.
• Baby remains conscious and alert.
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17. MANAGEMENT:
• The aims of treatment are_
 To remove the source of exotoxin.
 To neutralize the remaining circulating toxins.
 To provide supportive care until toxin is metabolised.
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18. SPECIFIC MEASURES:
• Washing and debridement of the infected site and administration of
antibiotics such as Benzyl penicillin or Metranidazole.
• Anti- toxin.
o Anti-tetanus serum (1,50,000-1,00,000 U).
o Human tetanus immunoglobulin (3,000-6,000 U).
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19. SUPPORTIVE MEASURES:
• Sedation by-
o Diazepam (0.1-0.2mg/kg).
o Pheno barbitone.
o Paraldehyde.
• Feeding by-
o NG Tube.
o Daily milk requirement- 100-120ml/kg/day.
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20. NURSING CARE:
• Clean the umbilicus/wound.
• Isolate the baby in dark and silent room.
• Change the posture.
• Cardio-respiratory monitoring.
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21. DIFFERENTIAL DIAGNOSIS:
• Sepsis.
• Meningitis.
• Neonatal seizures.
• Hypoxic Ischemic Encephalopathy.
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22. COMPLICATIONS:
• Aspiration Pneumonia.
• Lacerations of mouth and tongue.
• Intramuscular haematoma or rhabdomyolysis leading to hemoglobinuria
and renal failure.
• Vertebral fractures.
• Decubitus ulcerations.
• Autonomic disturbances.
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23. PREVENTION:
• Immunize the mother during pregnancy.
• Clean and safe delivery.
• Care of umbilical cord.
• Avoid early circumcision in male babies.
• Immunize the baby after birth.
• Training of dais (Foster mother/ Care taker).
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24. PROGNOSIS:
• Fatality rate mainly depends upon quality of supportive care.
• Main causes of death are respiratory failure and pneumonia.
• HR-
o In neonates- 60%
o In children- 20-50%
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25. GOOD PROGNOSTIC FACTORS:
• Incubation period- more than 8-10 days.
• Progression longer than 60 hours.
• Absence of fever.
• Local disease.
• Survival for 10 days.
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26. BAD PROGNOSTIC FACTORS:
• Duration between injury and onset of trismus is less than
7 days.
• Duration between trismus and onset of generalized
tetanic spasms is less than 3 days.
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