Treatment of tetanus neonatorum in a rural setting.

Dr Yong Yoon Foh Pejabat Perubatan, Hospital Daerah, Semporna. Lumber puncture was performed, and CSF sent for C/S and FEME. 1500 to 2500 units of ATS was administered intrathecally, using the same needle. Blood was sent for se calcium, glucose, electrolysis (to Tawau). Valium at 0.33 mg/kg given iv to stop the muscle spasms. Stat does only. Naso Gastric (N/G) tube was inserted for administration of medication and milk feeds. Medication consisted of Phenobarbitone 2 mg/kg q6H and Largactil 0.1 mg/kg q6H. Doses were increased slowly till all spasms were abolished. The doses were staggered so that patient would receive one of the two drugs every 3 hours. Iv fluids (Paeds Solution) was given at 150-180 mllkg.l24h for one day only and would be stopped the second day. Iv penicillin at 200,000 units per kg per 24h was given in 4 divided doses. Feeding with expressed breast milk (EBM) given via N/G tube was started on the second day of admission in usual amounts. If not available, then the babies would be given Nan/Special formula in the usual amount. The iv penicillin was given as intramuscular after 24hr and stopped after 10 days. If complications arose, such as abdominal distension, vomiting of feeds and frequent spasms then the oral feeds were stopped and IV fluids readministered. Tepid Sponging Nasopharyngeal Suction was done PRN and gently. The medications would be reduced gradually after the 10th day of admission (They were usually stopped at 16-18 days after admission.) Babies were discharged only if they were sucking well, there were no obvious muscle spasms, afebrile and the general condition well. Cases were reviewed at one month after discharge.