Clinical Manifestations

A baby with neonatal tetanus is beset with symptoms that are easy to recognize and usually appear 3 to 10 days after birth. Signs include difficulty with feeding and swallowing, generalized stiffness, spasms, and convulsions. The newborn can develop special problems relating to ventilation, hydration, and sedation. The first and most distinctive sign of neonatal tetanus is trismus, or a stiffening of the jaw, resembling a smile. The mouth will not open fully, resulting in a condition that has become known as risus sardonicus. Patients often have their legs and arms partially flexed, arms crossed over their abdomen, hands clenched, excessive flexion of the toes, stifled cry, and wrinkled face. Their body temperatures can reach 100° or higher. Sucking is impaired, thus making regular nursing impossible. That and general fussi-ness are the first symptoms most mothers notice. Respiratory complications commonly arise. Infants who die within 48 hours generally succumb to uncontrolled spasms or intense congestion of the liver, lungs, or brain. Newborns who die from the disease after 2 days generally die from bronchopneumonia. Other complications include aspiration pneumonia, acute gastroenteritis, and umbilical hernia.

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