Indian Pediatrics 2001; 38: 1316  

Neonatal Tetanus

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.