Tetanus neonatrum
Neonatal tetanus, also known as tetanus neonatorum, occurs in young infants of inadequately immunized mothers. It is a kind of generalized tetanus that is exhibited mainly by prevention of the release of the inhibitory neurotransmitters (i.e., disinhibition) and is initiated by tetanospasmin, an exotoxin created by Clostridium tetani. Contamination of the umbilical cord stump is the main cause. The typical, early manifestations are weakness and lack of ability to suck, continuing within hours to trismus, risus sardonicus, and ultimately generalized tetanic spasm, rigidity, and opisthotonus. Without treatment, neonatal tetanus has a poor outcome with a mortality rate above 90%. Mortality can result from asphyxia due to the spasm and hyper-sympathetic state. The managing goals are to neutralize its toxin, eradicate C. tetani, care for wound, and offer supportive care, such as mechanical ventilation, parenteral nutrition, sedation, neuromuscular blockade, and management of autonomic dysfunction.