Neonatal Tetanus

Clinical Description

Neonatal tetanus occurs as a result of the failure to use aseptic techniques in managing the umbilical stump in offspring of mothers who are poorly immunized.

Pharmacological

Antibiotics

• Metronidazole 30 mg/kg/day (maximum, 4 g/day) divided into 4 doses PO or IV for 10 - 14 days

Alternatively

• Benzyl penicillin 100,000 units/kg IV 6 hourly for 10 - 14 days

Neutralization of unbound toxin

• Human tetanus immunoglobulin (TIG) 500 units IM or IV.

Active immunization

• All patients should complete a series of immunizations with tetanus toxoid, beginning at presentation. See immunization protocol

Sedation

Diazepam of 0.1-0.2 mg/kg 2-6 hourly , titrating upward as needed. If not controlling the spasms, discuss with a senior for Phenobarbital children: 5 mg/kg STAT, then 2.5 mg/kg 12 hourly .

Neonates

• 10mg/kg STAT, then 2,5 mg/kg 12 hourly.

Monitor for respiratory arrest.

Consider ventilatory support (Indications for intubation: apnoea, hypoxaemia, uncontrolled spasms).

Adequate analgesia)

Non-pharmacological

• Nurse in a quiet and dark room
• Minimal handling
• Avoid IM injections where possible
• Maintain hydration
• Maintain nutrition (use NGT feeds)

Complications

• Respiratory failure
• Rhabdomyolysis
• Fractures

TETANUS PREVENTION

• Promote Tetanus Diptheria Vaccination (Td) in pregnant women and all women of child bearing age (see Section 12.3 )
• Ensure adequate surgical toilet plus passive (ATS 1,500 units IM )
• and active (Td) immunization after wounds, bites and burns
• Vaccinate all unvaccinated Childbearing age women in a locality with a confirmed case of Tetanus.

TETANUS TOXOID VACCINATION (TTV)

Fully immunized but last booster >10 years ago:

Give one booster dose of 0.5 mL IM

Fully immunized patients who have had a booster within the last 10 years do not need treatment with tetanus antitoxin (ATS) or tetanus toxoid vaccination (TTV)