Varicella and Neonate

Maternal Varicella Infection

VZIG (human varicella-zoster immunoglobulin) is recommended for infants born to a mother who develops chicken pox in the period 7 days before to 7 days after delivery. (The highest risk appears to be 5 days before to 2 days after delivery).

Exposed infants born before 28 weeks gestation or weighing less than 1000grams should be given VZIG as transfer of maternal IgG antibodies may be inadequate.

Infants > 28 weeks gestation may be VZV antibody negative, but should be serological tested, despite a maternal history of varicella or zoster.

Breastfeeding

Maternal varicella is not a contra-indication to breast feeding

Neonatal exposure to non-maternal Varicella Zoster

If the neonate has a significant exposure to chickenpox or shingles from a source other than the mother – e.g. Father, sibling, member of staff or another mother on the unit.

The mother should be asked about a past history of chickenpox or shingles. Babies of mother with a positive history will not require treatment. Mothers with no history or who are unsure should be tested for VZV antibodies. If the mother is seronegative, the infant will need a dose of VZIG, but does not need to be separated from its mother or siblings. If positive no further action is required.

If infant between 28 weeks to 36 weeks – the infant should be tested for VZV antibody. Even if the mother is seropositive, or has a past history of infection. The VZV antibody may not have crossed the placenta, be low or undetectable, despite the mother having had VZV exposure. If the infant is seronegative, it will require a dose of VZIG.

However, if <28 weeks and <1000kg. They should be given VZIG, as soon as exposure known. As transfer of maternal IgG antibodies may be inadequate, or non-existent. Even if the mother gives a positive history of having had the infection. Testing is also recommended in these infant, but not absolutely necessary.(Health Protection Agency).

Infants of mothers with shingles are not at risk as they will be protected by maternal antibodies.

Health Protection Agency

Risk assessment for neonates or infants with a confirmed significant exposure to chickenpox or shingles

 

Group

 

Criteria

 

Testing

 

Action

 

1

 

Neonates whose mothers develop chickenpox (but not shingles) in the period 7 days before to 7 days after delivery

 

Not required for mother or infant

 

Administer VZIG within 7 days of delivery OR within 7 days of onset of disease in the mother, whichever is later

 

2

 

Infants (<1yr) who have remained in hospital since birth with any one of the following:

 

-born before 28 weeks gestational age OR

 

– weighed less than 1000g at birth OR

 

-infants who have severe congenital or other underlying condition that require prolonged intensive or special care during the first year of life

 

Test for VZV antibody status in the infant only

 

Administer VZIG within 7 days if found to be VZV antibody-negative by a qualitative assay or <150 mIU/ml by a quantitative assay

 

3

 

Neonates exposed to chickenpox or shingles (other than in the mother) in the first 7 days of life.

 

Test either mother (preferred) or neonate for VZV antibody status for infants whose mothers have a negative or uncertain history

 

Administer VZIG within 7 days if found to be VZV antibody-negative by a qualitative assay or <150 mIU/ml by a quantitative assay

Treatment of neonates with varicella

If severe chickenpox develops despite VZIG, high dose intravenous aciclovir treatment of 20mg/kg every eight hours for at least seven days should be started as soon as possible.

Prophylactic intravenous aciclovir should also be considered in addition to VZIG for infants whose mothers develop chickenpox four days before to two days after delivery as they are at the highest risk of fatal outcome despite VZIG prophylaxis

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