Tetanus is a life-threatening noncommunicable disease caused by a potent neurotoxin produced by the bacterium Clostridium tetani.
Neonatal tetanus can be prevented through vaccination of women before or during pregnancy, which protects the mother and the baby through a transfer of tetanus antibodies. Hygienic childbirth practices are also important to prevent neonatal and maternal tetanus (NNT).
Mycobacterium tuberculosis, the etiological agent of tuberculosis (TB), is a leading cause of human disease and death, particularly in developing countries.
Worldwide, TB is intimately linked to poverty, making the control of TB a matter of justice and human rights.
In some areas with a high burden of TB, existing strategies for TB control cannot keep pace with the rising number of cases of TB occurring in parallel with the HIV/AIDS pandemic.
Emerging mycobacterial drug resistance further complicates the situation.
If the mother is HIV positive, the newborn should first be tested for HIV: if the child tests negative for HIV at 5 weeks of birth, he/she can get vaccinated with BCG.
In the case of hepatitis B vaccine, whether the mother or the baby are positive for HIV, the newborn can safely receive this vaccine as soon as possible after birth.
Maternal and neonatal immunization refers to immunization prior to pregnancy, during pregnancy, and during the post-partum period that is intended to provide protection to both the mother and her child.
This is a critical concept, as neonates and premature infants are particularly vulnerable to infections with vaccine-preventable diseases. Additionally, their immature immune systems cannot mount protective immune responses to specific vaccine antigens until several weeks or months after birth. This creates a gap during which newborns are extremely vulnerable.
The following signs should be assessed during each postnatal care contact and the newborn should be referred for further evaluation if any of the signs is present:
- stopped feeding well
- history of convulsions
- fast breathing
- severe chest in-drawing
- no spontaneous movement
- temperature >37.5 or <35.5 °C
- jaundice in the first 24 hours of life, or yellow palms and soles at any age.
The family should be encouraged to seek health care early if they identify any of the above danger signs in-between postnatal care visits.
For all neonates it is recommended topical ocular prophylaxis for the prevention of gonococcal (Neisseria gonorrhoeae) and chlamydial (Chlamydia trachomatis) ophthalmia neonatorum.
After birth, breastfeeding is initiated by the newborn if he/she is in direct and uninterrupted skin-to-skin contact with the mother for at least one hour after birth.
Bathing should be delayed to after 24 hours of birth. If this is not possible at all due to cultural reasons, bathing should be delayed for at least 6 hours. Appropriate clothing of the baby for ambient temperature is recommended, this should be 1–2 layers more than adults and a hat.
The mother and baby should not be separated and should stay in the same room 24 hours a day
Clean, dry cord care is recommended for newborns born in health facilities, and at home in low neonatal mortality settings.
Daily chlorhexidine (4%) application to the umbilical cord stump during the first week of life is recommended for newborns who are born at home in settings with high neonatal mortality (neonatal mortality rate >30 per 1000). Use of chlorhexidine in these situations may be considered only to replace application of a harmful traditional substance
The following are recommendations to consider when hospital discharge after neonatal admission, and even if the baby was born healthy and at term:
· avoid exposing the patient to crowds of people;
· avoid passive exposure to smoke from parents and other family members;
· limit contact between newborns and infected people as much as possible.
If parents and close caregivers present signs of flu or a cold:
· increase personal hygiene precautions, including hand hygiene;
· put a mask or a handkerchief over the mouth and nose while caring for newborns;