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Potentially life-threatening emergency
Neonatal varicella
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Neonatal varicella

Contributors: Craig N. Burkhart MD, Dean Morrell MD, Lowell A. Goldsmith MD, MPH
Other Resources UpToDate PubMed

Synopsis

This summary discusses varicella in neonates. Varicella in adults and children is addressed separately.

Neonatal varicella, or neonatal chickenpox, is infection with varicella-zoster virus (VZV) during the first 4-6 weeks of life. Neonates may be infected (1) in utero by transplacental viremia, (2) at birth by ascending infection, or (3) after birth by respiratory droplets or direct contact with infectious lesions. The incubation period of VZV is usually between 10 and 14 days; therefore, onset of symptoms within the first 10 days of life is usually caused by intrauterine transmission. Onset of symptoms after 10 days is usually indicative of postnatally acquired infection.

Intrauterine-acquired neonatal varicella is common in infants born to mothers who contract a primary varicella infection during the last 3 weeks of pregnancy. The severity of neonatal disease is dependent on the presence of transplacentally acquired maternal antibodies. Hence, onset of the rash of primary maternal VZV infection between 6 and 21 days prior to delivery allows for maternal antibody production, transplacental transfer to the fetus, and nonfatal neonatal varicella. Conversely, onset of maternal rash between 5 days before and 2 days after delivery does not allow sufficient time for maternal antibody production, and one can expect a fulminant course.

Postnatally acquired VZV infections are usually self-limited in healthy full-term infants. However, severe varicella may result in neonates less than 28 weeks' gestation or below 1000 grams at birth.

Codes

ICD10CM:
B01.9 – Varicella without complication

SNOMEDCT:
240469009 – Perinatal varicella

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Vesiculopustular rashes in the neonate may be divided into infectious, transient, or persistent dermatoses. The first goal in all vesiculopustular eruptions in the neonate is to rule out infectious etiologies.

Infectious vesiculopustular dermatoses
Transient noninfectious vesiculopustular dermatoses
Persistent noninfectious vesiculopustular dermatoses

Best Tests

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Therapy

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References

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Last Updated:02/06/2022
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Potentially life-threatening emergency
Neonatal varicella
Neonatal varicella (Uncomplicated) : Fever, Malaise, Tense vesicle, Umbilicated vesicle
Clinical image of Neonatal varicella
A close-up of vesicles on erythematous bases.
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