NEONATAL TETANUS

Neonatal tetanus is a notifiable disease

  • Caused by infection of the umbilicus through cutting of the cord with unsterile instruments or from putting cow dung or other unsuitable materials on the stump
  • Usually presents 3-14 days after birth with irritability and difficulty in feeding due to masseter (jaw muscle) spasm, rigidity, generalised muscle spasms. The neonate behaves normally for the first few days before the symptoms
    appear.

Management

General measures

  • Nurse in quite, dark and cool environment
  • Suction the mouth and turn the infant 30 min after sedative. A mucous extractor or other suction should be available for use prn
  • Ensure hydration/feeding
    • Start with IV fluids (half saline and dextrose 5%)
    • Put NGT and start feeding with expressed breast milk 24 hours after admission– in small frequent feeds
    • Monitor and manitain body tempeature
    • Monitor cardiorespiratory function closely. Refer for ICU management if possible

Neutralise toxin

  • Give tetanus immunoglobulin human (TIG)
    • 500 IU IM. Give the dose in at least 2 different sites IM, different from the tetanus toxoid site
  • In additon give 1st dose of DPT

Treatment to eliminate source of toxin

  • Clean and debride the infected umbilicus

First line antibiotics

  • Metronidazole loading dose 15 mg/kg over 60 min then
    • Infant <4 weeks : 7.5 mg/kg every 12 hours for 14 days
    • Infant >4 weeks: 7.5 mg/kg every 8 hours for 14 days

Second line antibiotics

  • Benzylpenicillin 100,000 IU/kg every 12 hours for 10-14 days

Control muscle spasm

  • Diazepam 0.2 mg/kg IV or 0.5 mg/kg rectal every 1 to 4 hours

Other medicines

  • Chlorpromazine oral 1 mg/kg 8 hourly via NGT

Prevention

  • Immunise all pregnant women during routine ANC visits
  • Proper cord care