Paediatrics Q20

Chickenpox in the Neonatal Period

Presentation:

1. The disease is caused by the Varicella Zoster Virus (VZV).

2. Typical symptoms include a sudden rash that can progress to vesicles filled with fluid.

Risk Factors:

. Risk of neonatal chickenpox is elevated if the mother develops the rash within a week of delivery or within 7 days after delivery.

. Transplacental transmission of the virus is possible, but the antibody IgG does not have enough time to develop, leaving the baby vulnerable.

Investigation:

i. Diagnostic tests usually include PCR tests or skin scrapings to confirm VZV infection.

ii. Maternal history of chickenpox or exposure is crucial for diagnosis.

Management:

1. High Risk (Mother’s rash appears within a 7 days before delivery or within 7 days after delivery):

Administer Varicella Zoster Immunoglobulin (VZIG) to the neonate as soon as possible.

Start Acyclovir treatment for the neonate.

The baby is at a 30% risk of severe complications like pneumonia or fulminant hepatitis, hence prompt treatment is essential.

2. Low Risk (Mother’s rash appears >7 days before or >7 days post-delivery):

    • VZIG and isolation for the neonate are usually not necessary.

Observation is the key, and no immediate pharmacological intervention is generally required.

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