Uganda guidelines for the treatment of Neonatal Tetanus

Case Definition (Notifiable)

Neonatal tetanus in a neonate: normal crying and suckling in first 2 days of life followed by inability to suck (lockjaw), then illness and death between day 3–28 of life.

Clinical Features

Trismus (lockjaw), risus sardonicus (fixed grin). Opisthotonus (arched back). Generalised spasms triggered by stimuli. Inability to suck or swallow. Poor feeding, irritability.

Source Control

Clean and debride the infected umbilical stump.

First Line Antibiotics

Benzylpenicillin 100,000 IU/kg IV every 12 hours for 7–10 days. OR Metronidazole 7.5 mg/kg IV or rectal every 6–8 hours for 7 days.

Neutralise Toxin

Tetanus immunoglobulin (TIG) 500 IU IM single dose. Give immediately before wound cleaning.

Sedation and Spasm Control

Diazepam 0.1–0.3 mg/kg IV every 2–4 hours as needed. OR Phenobarbital 5–10 mg/kg IM or IV every 12 hours.

Supportive Care

Keep in a quiet, dark room to minimise stimulation. Nutritional support by NGT. Maintain airway. IV fluids for hydration.

Prevention

Maternal tetanus toxoid immunisation during pregnancy (TT2+ schedule). Clean delivery practices: clean blade for cutting cord, clean cord care. Never apply traditional remedies to the umbilical stump.