1. Management infant born with mother Chickenpox

2. Literature review Literature review
Over 85 % of women of childbearing age in industrialised countries are immune to varicella zoster virus (VZV)
Varicella pneumonia complicates up to 10 % of cases of VZV in pregnancy
Perinatal varicella (chickenpox) carries a 20 to 30 % risk of transmission to the neonate

3. Route of transmission
Infection with chickenpox may occur through airborne / respiratory droplet and direct contact with vesicle fluid
Transmission based precautions (negative pressure room, immune staff in attendance, N95 mask) should be used when caring for a woman / baby with chickenpox
In herpes zoster (shingles), transmission of infection usually requires contact with vesicle fluid; however, there is also evidence of respiratory spread

4. Incubation period
10 to 21 days (may be up to 35 days in contacts given Varicella Zoster Immune Globulin,
Period of infectivity
48 hours before the onset of rash until crusting of all lesions (usually day 6 of rash)
Varicella (and herpes zoster) vesicles contain large numbers of virus particles. Ensure transmission based precautions (negative pressure room, immune staff in attendance, N95 mask) are used and all dressing materials treated as medical waste

5. Maternal VZV infection can cause three major manifestations:
1. Congenital defects secondary to intrauterine VZV infection 2. Neonatal chickenpox 3. Zoster (shingles) in infants

6. fetal varicella syndrome
Studies of maternal varicella in the first 20 weeks suggest a 2 – 2.8 % risk of fetal varicella syndrome. Subsequent abnormalities may include:
Skin scarring
Eye defects
Limb hypoplasia
Prematurity and low birthweight
Cortical atrophy, mental retardation
Poor sphincter control
Early death

7. Neonatal chickenpox
Disease begins in the neonate within the first 10 days of life
If an infant's mother develops varicella from 5 days before to 2 days after delivery,the infection is usually disseminated and fulminant , approximately 1/3 die, diffuse pneumonia, severe hepatitis and meningoencephalitis are the most common clinical manifestations.
skin vesicles DDx from neonatal HSV infection

8. Indication for VZIG
Immunocompromised children without history of chickenpox
Susceptible, pregnant women
Newborn infant whose mother had onset of chickenpox within the 5 days before delivery or within 2 days after delivery
Hospitalized premature infant (>28 wk GA) whose mother has no history of chickenpox or seronegativity
Hospitalized premature infant (<28 wk GA), regardless of maternal history

9. Isolation: airbone and contact precaution
1.Patient with varicella: minimum of 5 days after the onset of the rash and as long as the rash remains vesicular
2.Exposed, susceptible to varicella: 8-21 days after the onset of rash in index patient (28 days if received VZIG)
3.Immunocompromised patient with zoster (localized or disseminated)
4.Normal patient with disseminated zoster ( localized, normal pt needs only standard precaution)

10. Summery of Management Maternal Time Risk Treatment Isolation
- Varicella
1) 0-20 wk GA
Congential syndrome
Acyclovir, if life threatening to mother No
2) wk GA
Zoster in infancy
same as #1
3) 5 days before to 2 days after delivery
Severe neonatal chickenpox
VZIG to newborn, Acyclivir is symptomatic
Yes
4) around delivery except #3
mild neonatal chickenpox
closed observation
- Zoster
0-36 wk GA
none