Neonatal Tetanus

Neonatal tetanus is an acute infection caused by Clostridium tetani entering via the umbilicus, usually onset around day 7 of life; features are generalized skeletal muscle rigidity/trismus, hence called umbilical wind, seventh-day wind, or locked-jaw wind.

Common Symptoms

Yan Tie; trismus; dyspnea; Yi Yupin; sardonic facies; risus sardonicus; neonatal poor feeding; constipation; convulsions; opisthotonus; postoperative tetanus

Causes and Pathogenesis

(1) Etiology: C. tetani is a Gram-positive anaerobe widely distributed in soil, dust, and animal/human feces. Its spores are extremely resistant: survive decades in shaded soil, withstand boiling 60 min, dry heat 150°C/1 h, 5% phenol 10-15 h; killed only by autoclaving, iodine disinfectants, ethylene oxide. Infection occurs via unsterile scissors/ligature or unsterile hands/gauze at cord cutting; occasionally after poorly disinfected vaccination. C. tetani is non-invasive; disease is due to tetanospasmin, the second most potent toxin known (after botulinum), lethal dose ~10-6 mg/kg. (2) Pathogenesis: The necrotic umbilical stump lowers redox potential, allowing spore germination and toxin production. Toxin enters lymph/blood, binds globulin, reaches CNS; or is absorbed at neuromuscular junctions and ascends along peripheral nerve sheaths to spinal cord/brainstem. Once bound to gangliosides in CNS, antitoxin cannot neutralize it. By blocking inhibitory neurotransmitters (glycine, GABA) at synapses, it reflexively amplifies motor activity—flexors and extensors contract simultaneously; muscles used most suffer first (masseteric trismus, risus sardonicus, opisthotonus); sympathetic excitation causes tachycardia, hypertension, sweating.

Treatment

Drug therapy, supportive therapy

Preventive Measures

Neonatal tetanus is a major killer but fully preventable: 1. Clean delivery: heat scissors red-cool, or apply 2% iodine to scissors and cord ligature before use; leave a long cord stump; re-treat the cord aseptically within 24 h. 2. Emergencies: besides aseptic cord care, give (1) penicillin IM for 3-4 days; (2) TAT 1500-3000 U IM; (3) human tetanus immunoglobulin 75-250 U IM. 3. Maternal toxoid: since maternal/neonatal antibodies correlate, protective level is 0.01 U/ml; in late pregnancy give 2 doses of 0.5 ml tetanus toxoid 1 month apart, the second at least 2 weeks (preferably 1 month) before delivery. Chinese data show only 38.22% of fertile-age women have protective levels; vaccination programs should be accelerated in remote endemic areas.

Department to Visit

It is recommended to visit the Pediatrics department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.