What dose of human tetanus immunoglobulin (TIG) is recommended for newborns requiring tetanus prophylaxis?

Tetanus Immunoglobulin Dosing for Newborns

For newborns requiring tetanus prophylaxis, the recommended dose of human tetanus immunoglobulin (TIG) is 250 units administered intramuscularly, which is the same standard prophylactic dose used for both adults and children. 1, 2

Standard Prophylactic Dosing

• The CDC recommends a uniform dose of 250 units intramuscular for all age groups, including newborns, when TIG is indicated for tetanus prophylaxis 1, 2
• This dose applies regardless of patient size or age—the same 250 units is used for neonates, children, and adults 1, 2
• TIG must be administered at a separate anatomical site from any tetanus toxoid-containing vaccine, using separate syringes 1, 2, 3

When TIG is Indicated in Newborns

• TIG is indicated for newborns with tetanus-prone wounds (contaminated with dirt, feces, soil, saliva, or puncture wounds) who have unknown or incomplete maternal vaccination history 1, 2
• For clean, minor wounds, TIG is not required regardless of vaccination history 1, 2
• Newborns born to mothers who received inadequate tetanus vaccination during pregnancy may require TIG if they develop tetanus-prone wounds 1

Prevention of Neonatal Tetanus

• The primary strategy for preventing neonatal tetanus is maternal vaccination during pregnancy, not routine TIG administration to newborns 1
• Pregnant women should receive Tdap at 27-36 weeks' gestation during each pregnancy to provide passive immunity to the newborn 3
• If a previously unimmunized woman receives at least 2 properly spaced doses of tetanus toxoid-containing vaccine during pregnancy, the risk of neonatal tetanus is minimal 1

Important Clinical Considerations

• There is no weight-based dosing adjustment for TIG in newborns—the full 250 units should be administered 1, 2
• When both TIG and tetanus toxoid are needed, they must never be mixed in the same syringe or given at the same injection site 1, 3
• Research suggests intrathecal TIG (250 IU) may be more effective than intramuscular administration for treatment of established tetanus, though this is not standard prophylactic practice 4, 5, 6

Common Pitfall to Avoid

• Do not reduce the TIG dose for newborns based on weight—the 250-unit dose is standardized across all ages and is not adjusted for pediatric patients 1, 2