Pediatric emergency medicine trisk 2480 2480
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Neonatal Varicella
Current Evidence. Neonatal varicella may develop when maternal varicella
infection occurs during last 2 to 3 weeks of pregnancy or the first few days
postpartum. The severity of neonatal disease depends on timing of maternal
infection. If maternal disease onset is 5 or more days before delivery, the
infection in the newborn is usually mild because of transplacental passage of
maternal varicella IgG antibodies. If maternal disease is within 4 days before
delivery the neonate is at risk of developing severe infection, with mortality as
high as 30% caused by pulmonary or visceral involvement. Infants born to
mothers who demonstrate chickenpox lesions within 2 to 5 days of delivery
should receive varicella zoster immunoglobulin.
Clinical Recognition. The classic rash is described as vesicles on an
erythematous base, or “dew drops on a rose petal” ( Fig. 96.8 ).
Goals of Treatment. Early recognition, support, and prompt initiation of antiviral
therapy for moderate to severe cases of varicella.
FIGURE 96.8 Varicella infection. (Reprinted with permission from Burkhart C, Morrell D,
Goldsmith LA, et al. VisualDx: Essential Pediatric Dermatology . Philadelphia, PA: Lippincott
Williams & Wilkins; 2009.)
