In some regions of the world, tetanus neonatorum is known as "seventh day evil" [1], because this is when symptoms first set in. In underdeveloped countries, this is the cause of up to half of neonatal deaths, while infection of all types represents the reason for 15% of newborn deaths worldwide [2]. Newborns develop the generalized form of the disease because exposure is made via the umbilical stump, when asepsis is not achieved. Other infectious agents leading to sepsis can also be transmitted to the child in this manner [3]. In some areas, the umbilical stump is covered with dust or spider webs, that are thought to promote healing, but actually contain Clostridium tetani. Proper umbilical cord handling [4] and population vaccination may help reduce tetanus neonatorum .

The incubation period for tetanus neonatorum is 3 to 10 days, but most newborns develop it at the end of their first week of life, when they present with irritability, feeding difficulties due to trismus and an inability to swallow, excessive crying caused by hunger, rigidity and generalized muscle spasms induced by touch, including those of the face, and opisthotonus. Patients exhibit tachycardia and tachypnea, are febrile and may have convulsions. The sooner generalized spasms occur, the worse the prognosis, with mortality usually higher than 70% [5] [6] [7]. During spasms, the child may be cyanotic. Death is caused by hemodynamic instability as a consequence of dysautonomia or heart arrhythmias, hydro-electrolytic imbalance or asphyxia.

• Fever

  Short incubation period, short period of onset, low birth weight, presence of fever and tachycardia were associated with a poor prognosis. The cases were divided into 2 groups of 46 and 30. First group was given TIG while second group was given ATS. [ncbi.nlm.nih.gov]

  الصفحة 99 - An extremely infectious disease with a sudden onset, fever, malaise, headache, severe backache, prostration and occasionally abdominal pain. [books.google.com]

  Seite 99 - An extremely infectious disease with a sudden onset, fever, malaise, headache, severe backache, prostration and occasionally abdominal pain. [books.google.de]

  My thanks are due to the staff of the Baghdad Fever Hospital for permission to use their records. [kundoc.com]

• Hyperthermia

  […] acts at the level of the preganglionic nerves, causing sympathetic hyperexcitability, increased circulating catecholamine levels, thereby leading to dysautonomia and consequent systemic blood pressure instability, heart arrhythmias, diaphoresis and hyperthermia [scielo.br]

• Anemia

  Stay current on the developments and research surrounding neonatal anemia from the entirely new chapter on Blood and Hematopoietic System highlights. [books.google.com]

• Abdominal Rigidity

  A common first sign suggestive of tetanus in older children and adults is abdominal rigidity, although rigidity is sometimes confined to the region of injury. Generalized spasms occur, frequently induced by sensory stimuli. [cdc.gov]

  He developed tetanic generalized spasms with opisthotonos, risus sardonicus and abdominal rigidity. The patient was transferred to the PICU where he was placed on a continuous infusion of midazolam at 0.1 mg/kg/hr. [pedsccm.org]

• Trismus

  The incubation period for tetanus neonatorum is 3 to 10 days, but most newborns develop it at the end of their first week of life, when they present with irritability, feeding difficulties due to trismus and an inability to swallow, excessive crying caused [symptoma.com]

  Tetanus Neonatorum or neonatal tetanus is also known in Western medicine by the terms trismus nascentium, 7-day sickness, 9-day fits and the lock-jaw of infants. In ancient Chinese medicine it was called infant cord body stiffness. [nature.com]

  Omphalitis of newborn NOS tetanus A33 Tetanus, tetanic (cephalic) (convulsions) A35 ICD-10-CM Diagnosis Code A35 Other tetanus 2016 2017 2018 2019 Billable/Specific Code Type 1 Excludes obstetrical tetanus ( A34 ) tetanus neonatorum ( A33 ) neonatorum A33 Trismus [icd10data.com]

• Tachycardia

  Short incubation period, short period of onset, low birth weight, presence of fever and tachycardia were associated with a poor prognosis. The cases were divided into 2 groups of 46 and 30. First group was given TIG while second group was given ATS. [ncbi.nlm.nih.gov]

  Patients exhibit tachycardia and tachypnea, are febrile and may have convulsions. The sooner generalized spasms occur, the worse the prognosis, with mortality usually higher than 70%. During spasms, the child may be cyanotic. [symptoma.com]

  Tachycardia. High frequency and greater severity and duration of muscular spasms especially of larynx. Frequent and prolong duration of apneic episodes. [jemds.com]

  Beta-blockade is used to control episodes of hypertension and tachycardia, but use of long-acting drugs such as propranolol is not recommended. [msdmanuals.com]

• Muscle Twitch

  twitches are fused and cannot be distinguished from one another; called also tetanic or tonic contraction and tetanic or tonic spasm. tet·a·nus ne·o·na·to·rum tetanus occurring in newborn infants, usually due to infection of umbilical area with Clostridium [medical-dictionary.thefreedictionary.com]

  twitches are fused and cannot be distinguished from one another, also called tonic spasm and tetany). tetanus 1. [wordinfo.info]

• Muscle Spasticity

  Dantrolene Dantrolene is sometimes prescribed in cases of chronic (long-term) muscle spasticity (where your muscles are overly tight or rigid). [hse.ie]

  Dantrolene (loading dose 1.0 to 1.5 mg/kg IV, followed by infusion of 0.5 to 1.0 mg/kg q 4 to 6 h for 25 days) relieves muscle spasticity. Dantrolene given orally can be used in place of infusion therapy for up to 60 days. [msdmanuals.com]

• Facial Spasm

  “Risussardonicus” or “rigid smile” is characteristic in the facial spasms caused by tetanus in which the eyebrows are raised and there is a fixed smile. [pchrd.dost.gov.ph]

• Convulsions

  As for any patient subject to convulsions, maintenance of a safe environment is essential. Prevention of injury to and assessment of a patient with convulsive seizures are discussed under convulsion. [medical-dictionary.thefreedictionary.com]

  Patients exhibit tachycardia and tachypnea, are febrile and may have convulsions. The sooner generalized spasms occur, the worse the prognosis, with mortality usually higher than 70%. During spasms, the child may be cyanotic. [symptoma.com]

  SJAMSIR DAILI; EMIL JAHJA and PARMA OEMI ASNIL : Valium as anti-convulsant in tetanus. Paediatr. Indones. 12 : 229 (1972). SUNARTO and DRADJAT BUDIMAN Valium in the treatment of tetanus neonatorum. Paediatr. Indones. 12 : 221 (1972). [paediatricaindonesiana.org]

  Omphalitis (congenital) (newborn) P38.9 ICD-10-CM Diagnosis Code P38.9 Omphalitis without hemorrhage 2016 2017 2018 2019 Billable/Specific Code Code on Newborn Record Applicable To Omphalitis of newborn NOS tetanus A33 Tetanus, tetanic (cephalic) (convulsions [icd10data.com]

• Seizure

  Diagnosis had to be differentiated between MSUD and other metabolic disorders and neonatal infections (especially neonatal tetanus because of severe opisthotonos) and generalized seizures of the patient. [ncbi.nlm.nih.gov]

  Tetanus was frequently confused with neonatal seizures at time of presentation. All infants were delivered at home. Mean age of onset of symptoms of poor suck, hypertonicity, and generalized spasms was 5.4 days with hospital admission at 6.4 days. [pediatrics.aappublications.org]

  As long as the patient is acutely ill and likely to suffer from convulsive seizures, someone should be in constant attendance. [medical-dictionary.thefreedictionary.com]

• Opisthotonus

  […] their first week of life, when they present with irritability, feeding difficulties due to trismus and an inability to swallow, excessive crying caused by hunger, rigidity and generalized muscle spasms induced by touch, including those of the face, and opisthotonus [symptoma.com]

  Related Concepts SNOMET-CT Tetanus neonatorum (disorder) Tetanic opisthotonus (disorder) Age at onset of clinical finding (observable entity) 29.0 days ICD-10-CM Alphabetical Index References for 'A33 - Tetanus neonatorum' The ICD-10-CM Alphabetical Index [icd.codes]

  LXXI NO. 12 On examination the baby is found to have trismus, and, if in a more advanced stage of disease, may have developed generalised rigidity with opisthotonus. [kundoc.com]

  Subsequently, hypertonia, opisthotonus and generalized spasms occur. Table 1 summarizes Bazin's (10) categorization of tetanus neonatorum. [scielo.br]

  Clinical feaClinical fea tures of neonataltures of neonataltetanustetanus Abdominal muscles become rigid andAbdominal muscles become rigid andspasms of the muscles of the back mayspasms of the muscles of the back mayresult in opisthotonus.result in opisthotonus [slideshare.net]

• Neonatal Seizures

  Tetanus was frequently confused with neonatal seizures at time of presentation. All infants were delivered at home. Mean age of onset of symptoms of poor suck, hypertonicity, and generalized spasms was 5.4 days with hospital admission at 6.4 days. [ncbi.nlm.nih.gov]

Tetanus neonatorum diagnosis is mainly clinical. Careful history inquiry should include metoclopramide administration. The clinician should search for meningeal signs [8] and labor related cerebral injury. Once the suspicion is raised, the physician is required to perform a spatula test. This consists of trying to elicit a gag reflex by touching the oropharynx with a spatula. In tetanus newborns, this reflex is replaced by masseter muscles spasm, leading them to byte the spatula. This maneuver is highly specific [9] and is sometimes involuntarily performed by mothers while attempting to feed the baby. The next step in the clinical evaluation is to assess the severity of the disease, based on the state of the limbs: flexed or extended and the presence of generalized rigidity.

Laboratory workup offers little information, because no specific diagnosis test is available. Serum muscle enzyme levels are increased due to the muscle spasms. The calcium blood level should be measured in order to exclude hypocalcemia, which is an important differential diagnosis. If an antitoxin level test is feasible, a titer of more than 0.01 IU/mL is considered to be protective. Umbilical stump secretion can be cultured and the bacteria may be found there, but this does not necessarily mean the patient has tetanus. On the other hand, in a patient with clear clinical signs of tetanus, the pathogen may be absent from the secretion. Blood cultures are not useful in this disease.

The electrocardiogram may show nonspecific changes or several types of arrhythmia, while the electromyogram describes continuous discharge of motor subunits, the substrate of spasms and rigidity.

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