Neonatal varicella

Neonatal varicella
Chickenpox exanthem (macules, papules, vesicles and crusts)
SpecialtyPediatrics
SymptomsFever, spots, small bumps, small blisters, crusting
ComplicationsPneumonia, hepatitis, meningoencephalitis, death[1]
Usual onsetBirth[2]
CausesVaricella zoster virus in late pregnancy[2]
Risk factorsChicken pox in late pregnancy[2]
Diagnostic methodVisualisation, PCR of blister swab[1]
Differential diagnosisNeonatal herpes[1]

Neonatal varicella is chickenpox infection in a newborn baby.[2] Symptoms may be present at birth or begin a few days later, typically with a fever followed by an eruption of spots that become small bumps which progress to small blisters before crusting.[1] These spots generally start on the head, and appear at various stages of development, before usually healing over a course of a week to ten days.[1] Complications include pneumonia, which may lead to death of the baby.[2] Other complications include hepatitis and meningoencephalitis.[1]

An affected baby typically contracts the Varicella zoster virus from their chickenpox affected mother during delivery, via direct contact with blood and chickenpox spots.[2] Less commonly, infection may occur via the placenta in the 20 days before birth, or just after birth by direct contact with respiratory droplets or skin.[2] When an unborn baby is infected in early pregnancy, it may result in congenital varicella syndrome.[1] Neonatal varicella may be more severe with a risk of death of 30% if the mother develops chickenpox between the five days before giving birth and the two days after.[1][3] Babies born After 5 days of the mother's onset of chickenpox are generally expected to have milder illness due to the mother's antibodies having crossed the placenta.[3] Diagnosis is by visualisation and a history of maternal varicella, though PCR of swabs of the blisters may help if uncertain.[1] Neonatal herpes may appear similar.[1]

Prevention is by vaccinating women who are not immune to chickenpox with the chickenpox vaccine.[2] Administering VZIG may prevent the disease in an exposed baby.[1] IVIG and aciclovir are alternative preventatives.[1] Treatment includes isolation and aciclovir.[1] Breastfeeding can continue.[1]

The infection presents in up to half of babies born to mothers infected with varicella in the last three weeks of pregnancy.[2]

Signs and symptoms

  • Neonatal varicella (macules, papules, vesicles and crusts)
    Neonatal varicella (macules, papules, vesicles and crusts)
  • Neonatal varicella (macules, papules, vesicles and crusts)
    Neonatal varicella (macules, papules, vesicles and crusts)

Complications

  • Chest X-ray: Diffuse interstitial syndrome in both lungs
    Chest X-ray: Diffuse interstitial syndrome in both lungs

See also

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Singh, Srijan; Sharma, Akash; Rahman, Mohammad Mozibur; Kasniya, Gangajal; Maheshwari, Akhil; Boppana, Suresh B (2022). "Congenital and Perinatal Varicella Infections". Newborn (Clarksville, Md.). 1 (3): 278–286. doi:10.5005/jp-journals-11002-0040. ISSN 2769-514X. PMID 36540194. Archived from the original on 2023-09-10. Retrieved 2023-09-09.
  2. 1 2 3 4 5 6 7 8 9 Blumental, Sophie; Lepage, Philippe (30 May 2019). "Management of varicella in neonates and infants". BMJ Paediatrics Open. 3 (1): e000433. doi:10.1136/bmjpo-2019-000433. ISSN 2399-9772. PMID 31263790. Archived from the original on 10 September 2023. Retrieved 8 September 2023.
  3. 1 2 Yeh, Sylvia H. (2022). "13. Varicella zoster virus infections". In Jong, Elaine C.; Stevens, Dennis L. (eds.). Netter's Infectious Diseases (2nd ed.). Philadelphia: Elsevier. p. 57. ISBN 978-0-323-71159-3. Archived from the original on 2023-09-13. Retrieved 2023-09-11.
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