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LETTERS TO EDITOR
Year : 2017  |  Volume : 18  |  Issue : 3  |  Page : 254-255

Late neonatal varicella


1 Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
2 Department of Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India

Date of Web Publication7-Jun-2017

Correspondence Address:
Amitabh Singh
Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi - 110 031
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.206087

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How to cite this article:
Choudhary P, Singh A, Jain R, Mandal A. Late neonatal varicella. Indian J Paediatr Dermatol 2017;18:254-5

How to cite this URL:
Choudhary P, Singh A, Jain R, Mandal A. Late neonatal varicella. Indian J Paediatr Dermatol [serial online] 2017 [cited 2017 Sep 25];18:254-5. Available from: http://www.ijpd.in/text.asp?2017/18/3/254/206087

Sir,

A 14-day-old newborn female baby was admitted with complaints of generalized polymorphic rashes over body for 3 days [Figure 1]a. She was born by normal vaginal delivery at home to a 30-year-old, second gravida mother at term gestation. The mother developed similar lesions 1 day before onset of labor. There was history of contact with her sister-in-law having similar illness. At presentation, the baby weighed 3.1 kg and had stable vital parameters. A clinical diagnosis of neonatal varicella was made and the baby was started on injection acyclovir at a dose of 10 mg/kg/dose 8 hourly along with strict maintenance of hygiene. She showed crusting and substantial reduction of skin lesions by day 19 of her life [Figure 1]b and was discharged on exclusive breast feeds on day 21 after 7 days of intravenous acyclovir therapy.
Figure 1: (a) Polymorphic generalized rashes. (b) Rashes showing crusting and partial resolution after acyclovir therapy

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Neonatal varicella occurs in babies of mothers who develop chickenpox during the last 3 weeks of pregnancy; the infection is usually transmitted from the mother to child by transplacental route, ascending infection during delivery, or by postnatal contact (respiratory droplet/direct).[1] The presentation of neonatal varicella depends on the time of maternal infection. If the mother develops rash on day 5 antepartum to day 2 postpartum, generalized neonatal varicella leading to death occurs in approximately one-fifth of cases. Neonatal chickenpox within the first 4 days after birth is usually mild. A fatal outcome has been reported in 23% of cases if neonatal chickenpox occurs between 5 and 10–12 days of age. If mother is symptomatic within 5 days before to 2 days after delivery, there is no time for transfer of varicella-associated antibody to the baby; thus, the baby has severe infection and usually it is fatal. If the mother has symptoms at least 5 days before delivery, the disease in infants is attenuated, as adequate maternal antibodies are transferred to the fetus.[1] Although, in our case, the mother was symptomatic 1 day before delivery and the baby did not receive varicella zoster immunoglobulin (VZV), fortunately, the baby did not have any of severe manifestations such as pneumonia, hepatitis, or encephalitis. Early and appropriate institution of therapy may have also helped in the same. This is of particular interest in a country like India, where most, if not all such babies with risk for severe neonatal varicella do not receive VZV in view of nonavailability and high cost.

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Sauerbrei A, Wutzler P. Neonatal varicella. J Perinatol 2001;21:545-9.  Back to cited text no. 1
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