A 6-day-old boy is brought to the emergency department for inability to feed for 12 hours. His parents report that the infant has been unable to open his mouth and has held his hands clenched all day. The infant was delivered at home by the grandmother. The mother had no access to prenatal care but says that the pregnancy was uncomplicated. The mother immigrated to the United States 6 years ago. Physical examination shows increased muscle tone throughout, arching of the back, and dorsiflexed feet. The umbilical cord is covered with a clump of soil. The mother says that it is customary in her village where she grew up to cover the umbilical stump with dung to speed cord separation. In addition to hygienic umbilical cord care, which of the following is the most effective strategy to prevent this condition?

Question

A 6-day-old boy is brought to the emergency department for inability to feed for 12 hours.  His parents report that the infant has been unable to open his mouth and has held his hands clenched all day.  The infant was delivered at home by the grandmother.  The mother had no access to prenatal care but says that the pregnancy was uncomplicated.  The mother immigrated to the United States 6 years ago.  Physical examination shows increased muscle tone throughout, arching of the back, and dorsiflexed feet.  The umbilical cord is covered with a clump of soil.  The mother says that it is customary in her village where she grew up to cover the umbilical stump with dung to speed cord separation.  In addition to hygienic umbilical cord care, which of the following is the most effective strategy to prevent this condition?

Quizplus · Accepted Answer

11ec160b_3860_7722_9249_6b1628bda137_MD0001_00 Neonatal tetanus (tetanus neonatorum) is a major cause of infant mortality in developing countries but is rare in the United States. Neonatal tetanus results from the introduction of Clostridium tetani spores to the infant, generally from unhygienic deliveries or cord care. Symptoms typically begin 5-7 days after birth and can progress more rapidly than in adults. Infected infants become irritable and have difficulty feeding and suckling due to tonic spasm of the masticatory muscles (trismus). As the disease progresses, spasms and hypertonicity become more generalized. Mortality approaches 100% without treatment. Prevention of neonatal tetanus focuses on vaccinating women who are pregnant or may become pregnant with inactivated tetanus toxin (tetanus toxoid). Appropriately vaccinated women provide transplacental IgG to the fetus, which decreases the incidence of neonatal tetanus by approximately 95%. (Choice A) Secretory IgA found in breast milk helps prevent respiratory and gastrointestinal infections in the newborn by providing mucosal immune support. However, adequate protection against neonatal tetanus requires the presence of toxin-neutralizing, circulating IgG antibodies that are obtained transplacentally. (Choices B and C) Treatment of tetanus, including neonatal tetanus, involves the use of antibiotics to kill C tetani and administration of tetanus immune globulin to neutralize unbound toxin. However, these agents are not used for tetanus prevention. (Choice D) Tetanus vaccination is not given at birth because the neonatal immune system is immature and unable to mount a proper memory immune response against the tetanus toxoid. The first dose of the diphtheria-pertussis-tetanus series is commonly administered at 2 months of age. In areas of endemic tetanus disease, this vaccine can be given as early as 4-6 weeks of age, but not earlier. Educational objective: Neonatal tetanus can be prevented by hygienic delivery and umbilical cord care and universal immunization of women who are pregnant or may become pregnant. Immunized mothers provide passive immunity via transplacental IgG, protecting infants until they receive active immunization (vaccination) around age 2 months. __________ References: Maternal and neonatal tetanus. (http://www.ncbi.nlm.nih.gov/pubmed/25149223) Vaccines for women to prevent neonatal tetanus. (http://www.ncbi.nlm.nih.gov/pubmed/23728640)

A 6-Day-Old Boy Is Brought to the Emergency Department for Inability