Abstract Ref Number = APCP978
NEONATAL TETANUS AFTER HOME DELIVERY IN RURAL AREA IN BANDUNG
Muhammad Kautsar,Muhammad Ilman,Lia Nazliah,Riza Prihadi
General physicians Bandung Maternal and Child Hospital West Java Indonesia Pediatric physicians Bandung Maternal and Child Hospital West Java Indonesia
Background : Neonatal tetanus is an important cause of neonatal death in developing countries. Since the advent of tetanus toxoid vaccination and routine aseptic delivery means, it has now become a rare disease in Indonesia. In 2016, The Health Ministry of Indonesia has reported 33 cases of neonatal tetanus with 14 cases of death. Traditional labor, not aseptic umbilical cord care, and the absence of tetanus toxoid vaccination during childhood have been reported as the risk factors of neonatal tetanus in Indonesia.
Case Presentation Summary : A full-term baby boy with birth weight of 2700 gram born at home was admitted to emergency unit at the age of 4 days. The infant exhibited poor feeding and icteric. The infant was diagnosed with neonatal jaundice and got phototherapy. Intermittent general seizure and lip cyanosis were observed on the night of admission. The patient was transferred to neonatal intensive care unit where seizure, four-limb spasticity and cyanosis were observed. Phenobarbital followed by phenytoin was prescribed for the seizure and the persistent spasticity. The seizure and the spasticity continued after treatment, especially occurred when the baby got external stimuli. The patient was diagnosed with Neonatal Tetanus. From anamenesia, we got information that the delivery was performed assisted by an untrained birth attendant, who performed non-aseptic cord-cutting using scissors. The patient's mother never got Tetanus Toxoid immunization during her entire of life and received no ANC during her pregnancy. Endotracheal intubation was performed to control spasticity and saturation. During the admission, the baby was fed with NGT, received Phototherapy, was put on IV antibiotics, atracurium IV, and minimal handling. Tetanus immunoglobulin (5000 IU) was administered intramuscularly 5 days after admission. Extubation was performed on day 36 and subsequently discharged 48 days after admission.
Learning Points/Discussion : It is important to give attention in ante-natal care of mother pregnancy and to educate pregnant women to have a safe delivery and get vaccinated in order to prevent another case of neonatal tetanus.
Keywords: Home Delivery Neonatal Tetanus Tetanus Immunization