The document provides a comprehensive overview of neonatal tetanus, detailing its risk factors, pathophysiology, clinical features, and complications. It covers the diagnosis and management, including both non-pharmacological and pharmacological treatments, as well as preventive measures to combat the disease. Key interventions include maternal immunization and proper care of the umbilical stump to reduce risk.

1. NEONATAL TETANUS
PREPARED

2. Learning objectives
• Dfn Neonatal Tetanus
• Explain risk factors/Aetiology of Neonatal Tetanus
• Explain pathophysiology of Neonatal Tetanus
• Explain clinical features and complications of Neonatal Tetanus
• Establish provisional and differential diagnosis of a patient with Neonatal Tetanus
• Determine appropriate investigations to be performed to patients with Neonatal
Tetanus

3. Cont…..
• Treat, conduct follow up and refer patients with Neonatal Tetanus
• Provide preventive measures to patients with Neonatal Tetanus.

4. Neonatal Tetanus
Is an acute and potentially lethal disease of nervous system caused by a
toxin(tetanospasmin) produced by clostidium tetani.
In neonates initial symptoms appear within 3 to 4 days of birth.
TYPES OF NEONATAL TETANUS
i. Generalized tetanus-Manifest within 3-14 days of birth as progressive difficultly in
feeding, associated with hunger and crying, paralysis or diminished movement,
stiffness, ridigity to touch and spasms with or without opisthotonos .
 The umbilical stump may hold remnants of dirt, dung, clotted blood or serum or it
may appear relatively benign.

5. Cont….
• localized- result in painful spasms of the muscles adjacent to the wound site and may
proced generalized tetanus
• Cephalic tetanus-is a rare form of localized tetanus involving bulbar musculature that
occur with wound s or foreign bodies in the head, nostrils or face. It is associated
with chronic otitis media.
-Characterized by retracted eyelids, deviated gaze, trismus, risus sardonicus and spastic
paralysis of the tongue and pharyngeal musculature.

6. Risk factors of Neonatal Tetanus
• Inadequate immunization of the mother
• Unsterile cutting or care of the umbilicus
• Application of foreign material on umbilicus eg Anmal dung

7. PATHOPHYSIOLOGY
Tetanus is an infectious disease caused by clostridium bacteria. The active anaerobic
bacteria lead to the production of a tetanus toxin, which enters the nervous system via
lower motor neurons and travels up to the spinal cord and brain stem.
The presence of the toxin can lead to the initiation of characteristic symptoms of
tetanus, such as lockjaw, dysphagia, opisthotonus and other muscular spasms. This is
due to the effect , the toxin exhibits on certain parts of the nervous system and
neurotransmitters, which interfere with muscular contraction in the body.

8. Clinical features
• Poor sucking, difficult in swallowing, then followed by
• Generalized muscle ridigity and painful spasm(eg opisthotomus position, stiffness of
the jaw, laryngospasm)
• Restlessness, irritability
• Weak cry
• Difficult in breathing, fast breathing, Apnea, cyanosis
• Sardonic smile(Risus sardonicus).
NOTE :Spasms can be set off by disturbances such as noises, light, and touch.

9. Complications
• Aspiration pneumonia
• Pneumothorax
• Seizures
• Spinal fractures
• Pulmonary embolism
• Gastric ulceration
• Mediastinal emphysema

10. Differential diagnosis
• Acute encephalitis
• Epileptic seizures
• Para pharyngeal
• Retropharyngeal
• Rabies
• Other drug reactions

11. Investigations
• A peripheral leukocytosis-result from secondary bacterial infection of the wound .
• CSF-Although the intense muscle contractions may raise intracranial pressure .
• Electroencephalogram

12. Treatments
• Non-pharmacological Treatment
Control light or noise in the room to avoid provoking spasms.
Rigorously cleanse the umbilical stump to stop the production of toxin at the site of
infection
• Pharmacological Treatment : For children amoxycillin-clavulanate(PO) via Nasal
Gastric Tube 20–30 mg/kg/day divided 8 hourly for 7 days . amoxycillin-clavulanate
(PO) via Nasal Gastric Tube 500mg 8 hourly for 7days AND : metronidazole (PO)
7.5mg/kg for postnatal age ≤7days: Weighing 1200–2000g: 7.5 mg/kg/day(PO) given
every 24 hours >2000 g: 15 mg/kg/day (PO) in divided doses every 12 hours.
Postnatal age >7days: 1200-2000g: 15 mg/kg/day (PO) in divided doses every 12
hours >2000 g: 30 mg/kg/day(PO) in divided doses every 12 hours for 7 days
OR : ceftriaxone (IV) 2g (50 mg/kg in pediatric patients older than 1 month)
12hourly for 7days .

13. Cont……….
• Cefotaxime (IV) 2g (50 mg/kg) in pediatric patients older than 1 month 6hourly for
5days. Administer human antitetanus immunoglobulin TIG, (IM) 100–300IU/kg stat,
with the dose divided into two different muscle masses to the confirmed infected
patients (Don’t give vaccine to the confirmed infected patients) AND diazepam
(PO) 0.5mg/Kg 8hourly as the effective management of muscle spasm via NGT.
• AND A: chlorpromazine (PO) 2mg/kg 8 hourly AND B: phenobarbitone (PO) 6mg/kg
12 hourly

14. Cont…….
• Diazepam- at 0, 3, 9, 15, 21, 24
• Chlorpromazine –at 3, 9, 15, 21.
• Phenobarbitone-at 0, 6, and 21.

15. Preventions
• Immunize the mother and other pregnant women in the same locality as the case
with at least 2 doses of tetanus toxoid
• Conduct a supplemental immunization activity for women of childbearing age in the
locality
• Improve routine vaccine coverage through IVD and maternal immunization program
activities
• Educate birth attendants and women of childbearing age on the need for clean cord
cutting and care. Increase the number of trained birth attendants

16. THANKS