Saturday, September 02, 2006

Neonatal Tetanaus

One morning in clinic I was called in to see a baby boy who was just three days old. The little boy’s hands were clenched and his back arched. His temperature was 105 F and he was unable to take his mother’s breast milk due to lock jaw. The baby had clinical signs of neonatal tetanus.

He was born at home and his umbilical cord cut with a nonsterile razor. His mother’s tetanus vaccinations hadn’t been adequate in number or possibly the vaccine “cold chain” was broken and they were not kept cold enough to retain their potency to allow the mom to mount an immune response to protect the baby.

Tetanus occurs when a very powerful toxin from a bacteria called Clostridium tetani climbs the nerves into the spinal cord. The nerve cells don’t communicate well when this happens and they begin sending too many signals to the muscles. The muscles go into spasm. This is what caused the Haitian baby’s jaw to lock and his hands to clench. His arched back is due to muscle contraction and is very painful. When contraction of the tracheal and pharyngeal muscles occurs, periods of apnea can occur, and the baby cannot breathe. Seizures and swings in blood pressure are common also.

There was one case of neonatal tetanus reported from the Dominican Republic in 2002 while Haiti reported 60 cases.

This is another tragic story. The baby appeared very well formed. Haiti’s infrastructure is pathetic. Low intensity warfare that exists in the developing world is killing its most vulnerable.

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