ffRefer to hospital immediately}<b>General measures</b><br>ffNurse in quite, dark and cool environment ffSuction the mouth and turn the infant 30 min after sedative. A mucous extractor or other suction should be available for use prn ffEnsure hydration/feeding –– Start with IV fluids (half saline and dextrose 5%) –– Put NGT and start feeding with expressed breast milk 24 hours after admission– in small frequent feeds –– Monitor and manitain body tempeature –– Monitor cardiorespiratory function closely. Refer for ICU management if possible}<b>Neutralise toxin</b><br>ffGive tetanus immunoglobulin human (TIG) –– 500 IU IM. Give the dose in at least 2 different sites IM, different from the tetanus toxoid site ffIn additon give 1st dose of DPT}<b>Treatment to eliminate source of toxin</b><br>ffClean and debride the infected umbilicus<br><b>First line antibiotics</b>ffMetronidazole loading dose 15 mg/kg over 60 min then –– Infant <4 weeks : 7.5 mg/kg every 12 hours for 14 days –– Infant >4 weeks: 7.5 mg/kg every 8 hours for 14 days<br><b>Second line antibiotics</b><br>ffBenzylpenicillin 100,000 IU/kg every 12 hours for 10-14 days<br><b>Control muscle spasm</b>: ffDiazepam 0.2 mg/kg IV or 0.5 mg/kg rectal every 1 to 4 hours<br><b>Other medicines</b> ffChlorpromazine oral 1 mg/kg 8 hourly via NGT