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Tetanus, commonly called lockjaw, is caused by a bacterium
that is present just about everywhere, but mostly in soil, dust, manure, and in the
digestive tracts of humans, as well as in many animals. Tetanus is not transmitted from
one person to another. Rather, the germs enter the body through a wound - sometimes one as
small as a pinprick or a scratch, but, more often, through deep puncture wounds and
lacerations, such as those made by nails and knives. Such wounds are difficult to clean
adequately, and if the tetanus bacteria were present on the nail or knife, they may remain
deep in the wound, where they may grow and produce a toxin, or poison, that attacks the
body's nervous system.
The first symptoms are likely to be headache, irritability,
and muscular stiffness in the jaw and neck. As the poison increases, the jaw, neck, and
limbs become locked in spasm, the abdominal muscles grow rigid, and painful convulsions
may occur.
Doctors treat the terrible symptoms of tetanus with powerful
tranquilizers and anti-spasmodic drugs. The symptoms last for several weeks and require
intensive hospital care. Complications of tetanus include pneumonia and fractures, and
simple exhaustion from the muscle spasms. In the United States, four in every 10 persons
who get tetanus die of it.
Hospital Release and Newborn Health
HealthNews
from the publishers of the New England Journal of Medicine
When is the ideal time for mothers and newborns to go home
from the hospital? Two studies in the July 23/30 Journal of the American Medical
Association don't resolve the question. Although the larger study suggests that
discharge just one day after birth may be detrimental to some babies, newborn health may
hinge more on a mother's knowledge and support at home.
The larger study compared 2,029 rehospitalized newborns with
8,657 others. Babies sent home within 30 hours of birth were 28 percent more likely to be
rehospitalized in the following week--primarily for jaundice, dehydration, or sepsis.
Those at greatest risk for rehospitalization were born to mothers who were younger than
18, had no other children, or went into labor early.
A smaller study found that babies who went home on the day of
birth or the next day were no more likely to be rehospitalized for feeding-related
problems than those discharged on day 3. Readmitted babies were more likely to have been
breastfed, firstborn, born prematurely, or born to mothers who had not completed high
school, were unmarried, or were receiving Medicaid.
Public outrage over "drive-through deliveries"--the
discharge of newborns 24 hours after birth--prompted federal legislation that, as of
January 1998, will require insurers to pay for at least 48 hours in the hospital after
childbirth.
An editorial accompanying the studies notes that the optimal
time for discharge may be impossible to determine and that the difference between a one-
or two-day hospital stay may not be significant.
HealthNews associate editor David
Rosen, MD, says babies should be seen by a doctor soon after discharge, but parents
should call earlier if they notice yellow skin that signals jaundice, any change in the
baby's appearance or behavior, or less than vigorous feeding or if a breastfeeding mother
is not producing milk. For feeding problems, you may be referred to a lactation
consultant. All mothers, he says, benefit from the help of a relative or friend who has
experience with babies.
"Whether discharge is 'early' or 'late,' the best
determinant of good outcomes is to have resources and support available in the first few
days after delivery," Rosen says.
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