GB 16393-1996 Diagnostic criteria and treatment principles for neonatal tetanus
Some standard content:
(GB163931996)
Diagnostic criteria and treatment principles for neonatal tetanus Preface
Neonatal tetanus is an acute infectious disease caused by the invasion of tetanus bacteria from the umbilicus and occasionally from the trauma of the newborn. Neonatal tetanus is a serious health problem in developing countries. In May 1989, the 42nd World Health Assembly passed a resolution to eliminate the disease by 1995. At the 1990 World Summit for Children, the Chinese government made a commitment to this. In order to meet the needs of prevention and control work, this standard is specially formulated. Appendix A of this standard is an appendix to the standard.
Appendix B of this standard is an appendix of reminders.
This standard is proposed by the Ministry of Health of the People's Republic of China. The responsible drafting unit of this standard: Tianjin Infectious Disease Hospital. The drafters of this standard: Zou Huanwen, Zhou Qinyu, Chen Baozhen. This standard is entrusted by the Ministry of Health to the Office of Supervision and Administration of Infectious Disease Prevention and Control of the Ministry of Health for interpretation. This standard is formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Infectious Diseases" and its "Implementation Measures for the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases".
1 Scope
This standard specifies the diagnostic criteria and treatment principles for neonatal tetanus. This standard applies to the diagnosis, reporting and treatment of neonatal tetanus by personnel of all levels and types of medical care and health and epidemic prevention institutions.
2 Diagnostic principles
Diagnosis mainly relies on typical and unique clinical manifestations and a history of lax sterilization during delivery or a history of local trauma to the newborn that has not been sterilized during delivery. If conditions permit, etiological examination can be performed (see Appendix B (Suggested Appendix)]. 3 Diagnostic criteria
3.1 There is a history of poor delivery process and umbilical cord disinfection during delivery, or a history of local trauma after birth without disinfection.
Clinical manifestations
4 to 6 days after birth, a few as early as 2 days or as late as 14 days. Early teeth clenched and sucking difficulties, followed by facial spasms with a wry smile. Paroxysmal tonic spasms of the limb muscles, spasms of the rectus abdominis muscles as stiff as a board, and stiff and arched neck. Spasms of respiratory muscles and laryngeal muscles can cause ventricular asphyxia, respiratory failure, and heart failure.
3.3 Anaerobic bacteria culture of secretions from the umbilicus or wound can obtain positive results for tetanus in some cases (about 30%). 3.4 Clinical diagnosis Diagnostic cases
Consistent with 3.1 plus 3.2.
4 Treatment principles (see Appendix A (Standard Appendix)) 4.1 Treatment of patients
4.1.1 General treatment and nursing care.
4.1.2 Tetanus antitoxin neutralizes unbound free toxin. 4.1.3 Antiseptics control spasms.
4.1.4 Antibiotics control inflammation.
4.1.5 Umbilical treatment.
4.1.6 Others.
4.2 Prevention
4.2.1 Promote the new method of delivery.
4.2.2 Tetanus toxoid immunization prevention is implemented for women of childbearing age or pregnant women in high-risk counties. Appendix A
(Standard Appendix)
New Treatment of neonatal tetanus
A1 Treatment of patients
A1.1 General treatment and care
A1.1.1 Keep quiet, keep warm, avoid sound, light and all unnecessary stimulation. Sedatives and anti-infective agents can be given first for necessary operations.
A1.1.2 Intravenous infusion, maintain intake, supplement nutrition, and nasogastric feeding can be performed after spasms are relieved. A1.1.3 Take good care of oral and skin cleaning. A1.2 Antitoxin
A1.2.1 Deep intramuscular injection of 500IU of human tetanus immunoglobulin (TIgG or TIG) once.
A1.2.2 When TIG is not available, use tetanus horse serum anti-tetanus toxin (TAT) 10,000-20,000IU intravenous drip once. TAT needs to be used before use Perform skin allergy test, and those who are positive should be given medication according to desensitization method. A1.2.3 For severe umbilical infection, TAT 500IU can be injected locally once. A1.3 Stoppers
The application effect of stoppers is the key to treatment. When using the drug, it is appropriate to ensure that the child has no spasm when not stimulated and only has increased muscle tension when stimulated.
A1.3.1 Diazepam is the first choice of stoppers, 0.3-0.5mg/kg body weight, once every 4-6h, diluted and slowly injected intravenously; it can also be administered through a gastric tube, 0.5mg/(kg time). A1.3.2 Phenobarbital 10-15mg/(kg time), once every 8-12h, intramuscular injection or intravenous drip. In severe cases, the dose can be increased to 15-20mg/(kg time). The maintenance dose is 5mg/(kg?day). A1.3.3 10% chloral hydrate 0.5mL/(kg time), gastric tube injection or enema A1,3.4 Amytal sodium, thiothral sodium, chlorpromazine, paraformaldehyde, etc. can be used as appropriate: A1.3,5 Pavulon (Pancuronium) is a neuromuscular blocker, used for critically ill patients with artificial respirators, 0.05~0.1mg/(kg time), once every 2~3 hours. A1.4 Antibiotics
Penicillin 200,000 IU/(kg:day), divided into intravenous drips, the course of treatment is 7~10d. Metronidazole 15~30mg/(kg day), divided into 2~3 intravenous drips, the course of treatment is 5~7d. A1.5 Umbilical treatment
Locally clean with 3% hydrogen peroxide solution or 1:4000 potassium permanganate solution, then apply iodine tincture, and then wipe with normal saline. 12 times a day.
A1.6 Others
A1.6, 1 Pay attention to maintaining nutrition and water and electrolyte balance. A1.6.2 Give oxygen in time.
A1.6.3 When convulsions, apnea or respiratory failure occur repeatedly, tracheal intubation or tracheotomy should be performed in time, and artificial respirator should be used.
A2 PreventionWww.bzxZ.net
A2.1 Popularization of sterile delivery
The basis of sterile delivery is to promote the "three disinfections", namely hand disinfection; disinfection of delivery instruments and dressings: disinfection of maternal vulva and umbilical cord segments of newborns.
A2.2 Improve the rate of hospital delivery.
A2.3 Implement tetanus toxoid (TT) immunization program for women of childbearing age or pregnant women: At present, the focus is on women of childbearing age aged 18 to 35 in high-risk counties. Women of childbearing age should first receive three injections of TT for basic immunization, with the interval between the first and second injections being no less than four weeks, and the interval between the second and third injections being at least six months. Pregnant women should receive two injections of TT, with the interval between the first and second injections being no less than four weeks. Reinforced immunization depends on the fertility situation, with the shortest interval between the fourth and third injections being one year; the shortest interval between the fifth and fourth injections being one year. See Table A1: Table A1 Immunization schedule
Second injection
Fifth injection
Interval between vaccination
First contact with women of childbearing age
At least 4 weeks after the first injection
At least 6 months after the second injection
At least 1 year after the third injection
At least 1 year after the fourth injection
Inoculation method: Inject 0.5 mL of TT intramuscularly in the deltoid muscle of the upper arm each time. No
Protection period
Incubation period
Contraindications: Patients with severe diseases, fever or allergic history, and those who have a nervous system reaction after TT injection are prohibited. A2.4 The dressing of the umbilical wound of the child should be incinerated, and the instruments used should be disinfected and sterilized separately. Appendix B
(Suggested Appendix)
Etiological diagnosis method
B1 Specimens are taken
Before the umbilical cord is disinfected and the tetanus antitoxin is injected, use a sterile cotton swab to take pus and necrotic tissue deep in the suppurative part of the umbilical cord. At least two specimens should be taken at the same time, one for smear microscopy and the other for animal testing. B2 Direct microscopic examination
Take the above specimens for direct smear, and observe the size, morphology and characteristics of the bacteria after Gram staining. The bacteria are 2-5μum long, 0.4-0.5μm wide, blunt at both ends, and have no capsule. This bacterium is a Gram-positive bacterium. Under the flagella staining microscope, flagella can be seen all over the body.
B3 Isolation and Culture
Tetanus bacillus is an obligate anaerobe, and the specimens need to be processed in anaerobic culture equipment (anaerobic box, anaerobic tank or anaerobic bag). The specimens were inoculated into several tubes of meat residue soup and milk culture medium, covered with vaseline, and then 1 to 2 tubes were heated to 80℃ for 10 minutes to kill the non-spore bacteria. The remaining tubes were not heated, but incubated at 37℃, and the bacterial growth was observed, and smear staining was performed for microscopic examination.
The specimens cultured at 37℃ can generate spores after 48 hours. The mature spores are round, and the immature spores are oval. The spores are larger than the diameter of the bacteria. The spores are located at the top of the bacteria, which swells the bacteria into a drumstick shape. In addition, the specimens were spread on blood agar plates (add appropriate amount of neomycin to the culture medium to inhibit the growth of bacteria) for anaerobic culture, and colonies were picked for biochemical reaction identification.
B3.1 Growth of tetanus bacillus on different culture media: B3.1.1 Cultured at 37°C in meat dregs broth culture medium, it grew well, the culture supernatant was slightly turbid, and a small amount of gas was produced, the meat dregs did not turn black and were not digested B3.1.2 Cultured at 37°C in milk agar culture medium, the culture medium became turbid. B3.1.3. After 3 days of culture at 37°C on blood agar medium, an α-hemolytic ring appears around the colony, which then turns into a β-hemolytic ring. B3.1.4. On agar plate medium, a round colony with a diameter of 2 to 5 mm can be grown in 4 days. The center of the colony is firm, and the surrounding is loose and cotton-like. The colony is gray-yellow, translucent, and has a rough surface. The edges are irregular. During isolation and culture, since the bacteria easily spread on the surface of the culture medium, a thin film is often formed, making it difficult to obtain pure colonies. B3.1.5. When cultured in broth at 37°C, mild turbidity and a small amount of granular precipitation may occur, which does not disperse when shaken, and has a fecal odor. B4. Biochemical reaction identification
B4.1. Glucose, maltose, lactose, and sucrose fermentation (decomposition) tests are all negative. It does not decompose sugars but can form indole. B4.2. Milk digestion test is negative.
B4.3. Salicin fermentation test is negative.
. Nitrate reduction test is negative.
Catase test negative.
Methyl red test negative.
Methylene blue test negative.
Methyl acetyl carbinol (VP) test negative.
Mannose fermentation negative.
Mannitol fermentation negative.
Lipase fermentation negative.
Lecithinase negative.
Indole production.
B4.14Gelatin hydrolysis (liquefaction) test positive
B5Animal test
Take the culture of meat residue soup, remove the bacteria in the culture through the filter, and use the filtrate for animal test method: Take three groups of mice, 10 mice in each group. Group A is injected with 0.5mL of filtrate in the muscle at the rear of the hind legs. Group B is first injected with 0.5mL of tetanus antitoxin diluted 1:10 by intraperitoneal injection for 1h, and then injected with 0.5mL of filtrate as a control.
Group C was injected with 0.5 mL of the filtrate heated to 100℃ for 30 minutes. If tetanus toxin is present in the culture filtrate, mice in Group A will become ill within 12 to 24 hours, with tail lifting, leg rigidity, spasm or paralysis, and may also develop whole body convulsions or even death. Mice in the other two groups did not become ill.
Tip: This standard content only shows part of the intercepted content of the complete standard. If you need the complete standard, please go to the top to download the complete standard document for free.