Neonatal Tetanus : Definition, Causes and Prevention

Definition of Neonatal Tetanus

Tetanus is a neurological disorder (caused by gram-positive rod Clostridium tetani) which is characterized by increased in muscle tone and muscle spasms. If tetanus occurs in neonates (neonate is a baby of age less than 4 weeks or 28 days) it is called “neonatal tetanus”. Neonatal tetanus is commonly seen in the first 2 weeks of life.

Causes of Neonatal Tetanus

Tetanus is caused by bacteria Clostridium tetani, which is gram-positive rod. Clostridium tetani is a motile and an anaerobic (grows in absence of air or oxygen) organism. Clostridium tetani is worldwide in distribution and found in soil, animal feces, and inanimate objects (at the tip of thorns, iron nails and in many other objects) and sometimes even in human excreta.

The specialty of Clostridium tetani is its ability to form “spores” which are colorless, oval, and look like drumstick or tennis racket. The spores can survive for years (may be decades) in some environment and become vegetative form when the environment is favorable. The spores of Clostridium tetani are resistant to boiling for 20 minutes and also resistant to several disinfectants, which makes it very difficult to remove from environment. But the vegetative forms are easily deactivated by various antibiotics (penicillin, metronidazole etc.) and normal disinfection procedures.

Prevention of Neonatal Tetanus

Neonatal tetanus can be effectively prevented by adapting asceptic techniques during delivery and by conducting delivery in hospitals (institutional delivery). If the delivery is done at home (as is the practice in many developing countries) the umbilical cord should be cut with sterile instrument/blade.

As part of prevention, active immunization of all pregnant women with tetanus toxoid should be done. For the first time pregnancy 2 doses of tetanus toxoid should be administered intramuscularly in the deltoid muscle during 16th to 28th week of pregnancy with at least 4 weeks apart, irrespective of immunization status against tetanus. During subsequent pregnancies, single tetanus toxoid should be administered intramuscularly during 16th to 28th week of pregnancy to prevent neonatal tetanus.

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