Umbilical stump sepsis in a nonpassive immunized neonate poses a high risk to neonatal tetanus. Management of neonatal tetanus is still a great challenge in resource limited settings where some health facilities lack tetanus toxoid containing vaccines, ventilator support, and inaccessibility of tetanus immunoglobulin. Neonatal tetanus is a severe, often fatal disease caused by the toxin Clostridium tetani, a ubiquitous spore-forming bacterium found in high concentrations in the soil and animal excrements (including human beings). Neonatal tetanus is a generalized tetanus, which occurs in a neonate between 3-28 days of life. The WHO aimed at global elimination of neonatal tetanus. The case-fatality rate of neonatal tetanus without treatment approaches 100%, though with intensive care, this can be decreased to 10%-20%. The WHO estimated that there were 34000 neonatal tetanus deaths worldwide in 2015.
Methodology
In Abha private hospital, Saudi Arabia, a male baby 9 days old(Saheem Hassan,Yemeni ), delivered on 12-11-2020 with no antenatal care, via 20 years old mother. This neonate presented with typical features of neonatal tetanus and his umbilical stump was septic, discharging pus, which was most likely the entry route of the deadly C tetani. The symptom onset was between the first 24-48 hours of birth. A short incubation period is associated with a poorer prognosis in both neonatal and adult tetanus cases.
Results
on examination (upon admission to NICU), the patient was convulsing, tonic type with marked rigidity associated with cyanosis where aborted by valium and connected to oxygen supply by nasal prong. Recurrent attacks of generalized tonic fits with rigidity. the Patient is admitted to NICU. after that, admitted on nasal prong oxygen at first but the patient developed recurrent attacks of intractable fits, rigidity associated with cyanosis and needed to take continuous infusion of anticonvulsant medications, so the baby intubated and connected to MV on 19/11/2020.
Conclusion
on 9/12/2020 as the patient is ventilator dependent so ENT consultation is done where recommended tracheostomy, but the father refused and signed AMA paper and also signed on the DNR paper.
on 17/12/2020 the baby is extubated and connected to nasal prong oxygen, then gradually shifted to incubator oxygen with difficult weaning from incubator oxygen. management as a tetanus neonatorum so the baby has given both tetanus antitoxins and tetanus toxoid.