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April 1982

Picture of the Month

Am J Dis Child. 1982;136(4):365-366. doi:10.1001/archpedi.1982.03970400083022

Denouement and Discussion

Neonatal Tetanus

Manifestations  Early manifestations include excessive crying, feeding difficulties, increased muscle tone (especially of the jaw and neck muscles), easily induced muscular rigidity, and inability to open the mouth. Muscle spasms, which vary in severity, develop later and are followed by respiratory or cardiac arrest. Opisthotonos can occur early and may last two to three weeks.Attempts to open the infant's mouth precipitate the typical facies of tetanus neonatorum, which includes trismus, closed and tightly pinched lips, partially closed eyes, a wrinkled forehead, and a rigid chin; all of these produce the classic risus sardonic smile. Flexion of the toes and occasional cyanotic episodes secondary to asphyxia are also present. Flexion of the wrist is a late manifestation. Some or all of these findings may be induced by internal or external stimuli. Prognosis is guarded, and approximately 50% of these patients do not survive. As a