neonatal tetanus.pptxAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA

neonatal tetanus.pptxAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA

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  NEONATAL TETANUS PREPARED By P A. marrah
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  Learning objectives • DfnNeonatal 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
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  Cont….. • Treat, conductfollow up and refer patients with Neonatal Tetanus • Provide preventive measures to patients with Neonatal Tetanus.
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  Neonatal Tetanus Is anacute 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.
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  Cont….  localized- resultin 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.
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  Risk factors ofNeonatal Tetanus  Inadequate immunization of the mother  Unsterile cutting or care of the umbilicus  Application of foreign material on umbilicus eg Anmal dung
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  PATHOPHYSIOLOGY Tetanus is aninfectious 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.
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  Clinical features  Poorsucking, 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.
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  Complications  Aspiration pneumonia Pneumothorax  Seizures  Spinal fractures  Pulmonary embolism  Gastric ulceration  Mediastinal emphysema
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  Differential diagnosis  Acuteencephalitis  Epileptic seizures  Para pharyngeal  Retropharyngeal  Rabies  Other drug reactions
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  Investigations  A peripheralleukocytosis-result from secondary bacterial infection of the wound .  CSF-Although the intense muscle contractions may raise intracranial pressure .  Electroencephalogram
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  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 .
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  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
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  Cont…….  Diazepam- at0, 3, 9, 15, 21, 24  Chlorpromazine –at 3, 9, 15, 21.  Phenobarbitone-at 0, 6, and 21.
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  Preventions  Immunize themother 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
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  THANKS