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A home delivered 7-day-old female neonate
was brought with feeding difficulty, excessive cry and tonic spasms. The
mother was unimmunized and referred from rural area. Examination
revealed (Fig. 1) risus sardonicus, generalized spasticity and
brisk deep tendon reflexes. Tonic spasms were provoked by touching and
sound but consciousness was preserved. The umbilical stump was stained
with cow dung. Neonatal tetanus is a clinical diagnosis and Fig. 1
shows the typical risus seen in such newborns.
It is a belief that tetanus particularly neonatal
tetanus is a disease that is fast disappearing with increased
immunization coverage and therefore likely to be missed in routine
clinical practice. However, we still see patients of neonatal tetanus.
It is easily preventable by 2 tetanus toxoid injections and ‘5 cleans’
while conducting deliveries.
Ramesh L. Renge,
Archana B. Patel,
Department of Pediatrics and
Clinical Epidemiology Unit,
Indira Gandhi Medical College,
Nagpur, India.
Fig. 1.
Newborn showing risus sardonicus and generalized spasticity.
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