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Perinatal and neonatal varicella: timing and quantified risks

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Facts & Figures #116 — Edit

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• Maternal chickenpox during the final 4 weeks of pregnancy carries a significant risk of neonatal varicella infection.
• If maternal infection occurs 1–4 weeks before delivery, up to 50% of babies may become infected and approximately 23% develop clinical varicella despite passively acquired maternal antibody.
• Severe neonatal chickenpox is particularly associated with birth within 7 days of onset of the maternal rash or maternal rash developing up to 7 days after delivery.
• Where clinically safe, planned delivery should normally be avoided until at least 7 days after maternal rash onset to allow passive transfer of protective maternal antibodies.
• A baby born when maternal chickenpox occurred from 7 days before to 7 days after delivery requires neonatal prophylaxis as soon as possible with VZIG with or without aciclovir.
• Testing the neonate for evidence of infection before starting prophylaxis is not required in this high-risk peripartum interval.
• A neonatologist should be informed about every baby born to a woman who developed chickenpox at any gestation during pregnancy.
• Breastfeeding is acceptable if the mother wishes and is sufficiently well.
• If active chickenpox lesions are close to the nipple, milk should be expressed from that breast until the lesions have crusted.
• Expressed breast milk may be given to the baby receiving VZIG and/or aciclovir.

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Perinatal and neonatal varicella: timing and quantified risks

Facts & Figures #116 — Edit

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