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Key messages

  • Risk is higher when maternal chickenpox occurs before 20 weeks gestation.
  • Mortality rates for newborns infected with varicella are up to 30 per cent.
  • Fetal varicella due to primary infection with chickenpox in pregnancy is usually benign.
  • The introduction of the varicella vaccine has greatly reduced the incidence of infection among newborns.
  • Varicella-containing vaccines can be given to breastfeeding women. Most live vaccines have not been demonstrated to be secreted in breast milk.

Introduction - definition

Chickenpox is an infectious childhood disease. It is rare in infants and newborns due to passive immunity received from the mother. 

Varicella-zoster virus (VZV) is a double stranded encapsulated DNA virus belonging to the Herpes virus family (human herpes virus type 3, HHV-3). 

The incubation period from exposure to appearance of rash varies from 10 to 23 days with an average of 14 days.1 The presentation of the newborn after intrauterine infection with varicella depends upon the time of onset of infection in the mother. The highest risk to the neonate for exposure is seven days before birth and seven days after as passive immunity may not have been conferred to the newborn.1

Diagnosis

Diagnosis can be made clinically. If in doubt, diagnosis can be confirmed on PCR from vesicular swabs.

Algorithim’s 4-6 in Management of Perinatal infection on neonatal Management of Varicella gives clear guidance.

Baby with chickenpox
infant with varicella vesicles
Source: Wikimedia user ILJR, CC BY-Sa 2.5

 

Management

  • Clinical Guidance has been sought from the Management of Perinatal infections published by the Australasian Society for Infectious Diseases, 2014.
  • Pages 83-90 cover Varicella exposure for the maternal and neonatal period.

Follow up and documentation

  • This is dependent on whether the newborn develops neonatal Varicella
  • If the newborn is being observed as per flow chart of treatment, careful observation seven days post birth is crucial.
  • Full examination of the baby should be performed and involve the family, educating them on early signs of a vesicle.
  • Clinical documentation including the mother’s antenatal exposure is very important.
  • Involve/discuss with an  infectious disease consultant (this may be at a tertiary hospital if the health service does not offer this speciality) if you have any doubt regarding management or treatment.
  • Document observations in Victor newborn charts or as per Health Service Documentation policy.

References

1. Australasian Medical Journal [AMJ 2011, 4, 6, 291-293]

2. Management of Perinatal Infections (Australian Society of Infectious Diseases) Palasanthiran, Starr, Jones & Giles, 2014

3. Wikimedia Commons

4. Australian Immunisation Handbook

Get in touch

Maternity and Newborn Clinical Network
Safer Care Victoria

Version history

First published: October 2015

Last web update: March 2019

Review by: TBC

Uncontrolled when downloaded

Page last updated: 25 Mar 2019

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