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Neonatal varicella: a report of 26 cases
S Singalavanija1, W Limpongsanurak, S Horpoapan
1Division of Dermatology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.
Insights
Neonatal varicella, rare in newborns, presents with vesicular rash and potential complications like sepsis and pneumonia. Acyclovir therapy shows benefit in treating this condition, with no observed deaths in the study.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Varicella (chickenpox) infection is common in childhood but rare in neonates.
- Neonatal varicella poses significant health risks due to the immature immune system of newborns.
Purpose of the Study:
- To analyze clinical manifestations, complications, and treatment outcomes of neonatal varicella.
- To evaluate the efficacy of acyclovir in managing neonatal varicella cases.
Main Methods:
- Retrospective review of 26 neonatal varicella cases from 1988-1995.
- Categorization of cases into perinatal and postnatal varicella based on transmission timing.
- Analysis of clinical presentation, complications, and treatment with intravenous acyclovir.
Main Results:
- 26 cases of neonatal varicella observed, with equal male to female ratio and onset between 6-27 days.
- Perinatal varicella (n=12) and postnatal varicella (n=14) showed similar complication rates (sepsis, pneumonia, pyoderma, hepatitis).
- Intravenous acyclovir was administered to high-risk/severe cases, with no deaths reported.
Conclusions:
- Neonatal varicella can range from mild to severe, influenced by maternal infection timing and transmission route.
- Acyclovir therapy is beneficial for treating neonatal varicella, even without varicella-zoster immunoglobulin (VZIG).
- Prompt recognition and management are crucial for improving outcomes in neonatal varicella.
Abstract:
Varicella infection usually occurs in childhood and is uncommon in neonates. We reported 26 cases of neonatal varicella seen at the Queen Sirikit National Institute of Child Health, Bangkok, from 1988 to 1995. The sex ratio of male to female was equal. The age of onset was between 6 to 27 days. Twelve cases contracted varicella from mothers who were infected between 6 days before delivery to 2 days after delivery (perinatal varicella) and fourteen cases contracted varicella from mothers or siblings in the postnatal period (postnatal varicella). All babies developed vesicular rash. Intravenous acyclovir was given in high risk and severe cases (nine perinatal and three postnatal varicella patients). Complications of neonatal varicella included clinical sepsis 8 cases (30%), pneumonia 7 cases (26%), pyoderma 9 cases (35%) and hepatitis 1 case (4%). There was no statistical difference between the complications of perinatal and postnatal group (p > 0.05). No death was observed during this study. Clinical manifestations of neonatal varicella varied from mild to severe, depending on the onset of rash in the mother and baby and mode of transmission of the disease. Although we have no varicella-zoster immunoglobulin (VZIG), acyclovir therapy is beneficial in the treatment of neonatal varicella.
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