Umbilical tetanus lecture
Babies with umbilical tetanus are caused by cutting the umbilical cord that is not sterile such as bamboo, sickle, cutlery, etc. Usually at home, delivery falls, and delivery by unprofessional people
Tetanus is a toxic bacterial infection caused by the bacillus Clostridium tetani, gram (+), a common disease in developing countries, with a high mortality rate (34-50%) depending on the information. In the report of each country, the number of passed treatment also has the rate of sequelae (epilepsy, mental retardation, motor ...) not less.
Because the gram (+) bacillus is called Nicolaier (Clostridium tetani) in its active form or cocoon (spore) that enters the body through the umbilical cut, it is called umbilical tetanus.
Tetanus spores are found in soil, dust, water, animal feces (cattle) in the form of spores. Tetanus bacteria can tolerate high temperatures at 120 ° C for 15 minutes, at 90 ° C for 2 hours, and the right conditions for the spores to become active form are temperatures of 35-37 ° C and pH: 6.8-7.4.
Children with umbilical tetanus are caused by cutting the umbilical cord, which is not sterile such as bamboo, sickle, and cutlery. Usually at home, delivery falls, and delivery by unprofessional people.
Tetanus bacteria secrete two types of toxins:
The impact on the motor system of the nervous system causes convulsions and spasticity, this toxin is very strong, only 1 / 50,000 - 1 / 90,000 of the lml is enough to cause death of guinea pigs.
The second toxin causes red blood cell breakdown but is weak, easily destroyed.
Period of incubation disease
Since cutting the umbilical cord until the signs of jaw stiffening is the period without warning about tetanus, the incubation period is from 4 to 15 days, an average of 7 days, the more severe the short incubation.
The baby is fussy, stops sucking, the baby's mouth is tight, the baby is hungry but cannot suck, so the more they cry, now if the tongue is pressed down, the reaction is a sign of hard jaw (trismus). to the full-blown period (from a few hours to a day).
The disease is evident, the harder the jaw is, the two main symptoms appear: convulsions and spasticity.
Occurring spontaneously or stimulant (light, examination, holding and feeding) at that time the child's face is pinched, mouth is chubby, lip foam, two hands are tight. A seizure can last for a few minutes. Sometimes up to 5-6 hours in a row, if the convulsions are strong continuously, easily accompanied by a pause of breathing lasting 2-3 minutes, even up to 20-30 minutes due to the constriction of the larynx. At that time, the sound of the heartbeat slows down, if the heart sounds discrete, the pulse is difficult to catch, the limbs are cold, each stop of rabbits can be life-threatening for the child, or prone to superinfection and acidosis.
Muscle spasms :
Young people are bent, head tilted back, or arms closed, it often occurs after the first seizure and lasts throughout the treatment.
Temperatures can be normal but often rise above 37 ° C to 40-41 ° C is a coordinating factor for the seizure.
Digestive or constipation.
The umbilical cord often falls prematurely (100%) and is infected. It may be wet, pus or rotten.
The disease lasts 2-3 weeks, easily fatal in the first and second weeks of seizures, or complications of pneumonia.
Children past the second and third week usually progress better, the attack gradually subsides and the patient begins to open his eyes, cry, before, small, and then enlarged. During this time there is still an increase in tonicity. A few days later, the patient is able to breastfeed. Thus, about one month since the onset of illness, the child can suckle. But it takes about 1.5-2 months for the muscle tone to return to normal.
Take care of
When the umbilical tetanus is suspected, the child must be transferred to the hospital, before moving, there are a few things that can be done:
Put your child in a quiet place, in a dark room.
Clean the neck, groin, armpits, and areas with folds.
Wash and wash the wound with cool boiled water or 9% saline, 70 ° alcohol.
Aspirate or wipe the nasopharynx fluid off.
To express breastmilk for babies to eat with a small spoon, penicillin can be injected with 200,000 UI one time
children and take Valium 5mg X 1/2 tablet before moving.
Neurotoxin neutralization :
SAT X 20,000 units (1 corn).
Diazepan (Valium, Valium): 0.5-1 mg / kg / 24 hours divided every 3 hours, intramuscularly, orally.
Phenobarbital (gacdenan): 10-20 mg / kg / 24 hours divided every 4 hours, intramuscularly or oral.
Anti-apnea attacks :
Breathe oxygen through the tent with 40% oxygen concentration.
Mechanical ventilation endotracheal intubation.
Anti-bacterial infection :
Ampicillin 50-100 mg/kg/24 hours, in 4 divided doses intramuscularly or intravenously.
Gentamicin 2-4mg/kg /24 hours, in 4 divided doses intramuscularly or intravenously.
The human body has no natural immunity to this bacterium, so if you want to have immunity, you need to be vaccinated. Currently, due to good expansion of vaccination, umbilical tetanus disease is significantly reduced.
Sterile when cutting the umbilical cord
Midwives should wash their hands with soap under running water or cool boiled water, disinfect hands with alcohol or soak hands in an antiseptic solution.
Umbilical scissors, ligation, and umbilical cord should be steamed at 120 ° c for 20 minutes, or boiled for 2 hours.
Avoid touching the umbilical cord.
For pregnant women need to get 2 full vaccinations in the last 2 months. The second nose is one month after the first and must be at least 15-30 days before childbirth. Because the mother has
It is possible to transmit immunity against tetanus until the first month of life. This method proved safe and effective.
The International Conference on tetanus (1987) advocates a tetanus vaccination for all pregnant women with 5 injections:
First time: for women to visit medical facilities for any reason.
2nd time: after 4 weeks of injection once.
3rd time: 6-12 months after 2nd injection.
4th time: one year after 3rd injection, or during pregnancy, protect mother and baby for 10 years.
5th time: a year after 4 injections and that will protect both mother and child from tetanus for the rest of their life.
If the baby is born in a non-sterile condition and the mother has not been vaccinated against tetanus during pregnancy, a tetanus vaccination with the SAT 1500 unit, once intramuscularly after delivery, should be given.