Neonatal Tetanus

Neonatal tetanus results from Clostridium tetani contamination of the umbilical stump, usually in infants born to mothers without adequate tetanus immunity or where unsafe cord practices occur.

Tetanospasmin blocks inhibitory neurotransmission, causing generalized rigidity and painful spasms.

The infant initially feeds normally, then develops:

• Inability to suck
• Trismus
• Generalized rigidity
• Painful stimulus induced spasms
• Opisthotonus
• Autonomic instability

Diagnosis is clinical.

Laboratory confirmation is neither sensitive nor required.

• Admit to intensive neonatal care.

• Minimize light, noise and handling.

• Secure the airway and provide ventilatory support when required.

• Give human tetanus immunoglobulin as soon as possible according to available preparation and neonatal protocol.

• Treat the contaminated umbilical site.

• Give metronidazole to eradicate C. tetani.

• Control spasms with benzodiazepines, titrated carefully.

Survival does not provide reliable immunity. Begin active tetanus immunization after recovery.