Congenital varicella syndrome can occur when a pregnant woman catches chickenpox in the first 20 weeks, and the virus damages the baby's skin, limbs, eyes and brain. It is rare, but chickenpox shortly before or after delivery is a separate danger that can cause severe newborn infection.
Key symptoms
- Zigzag scars on the skin along one body area
- A small or underdeveloped arm or leg
- Low birth weight
- Seizures or developmental delay
- Poor vision
What you find on exam
- Cicatricial skin scars in a dermatomal pattern
- Limb hypoplasia with weak or missing muscles
- Eye defects: small eyes, cataracts or chorioretinitis
- Small head and abnormal tone
- Check the mother's history of rash and timing in pregnancy
Tests
- Prenatal ultrasound: limb defects, calcifications, growth restriction
- Varicella zoster virus PCR on lesions or other samples; infant IgM
- Head imaging for calcifications or brain atrophy
- Dilated eye exam and hearing test
Treatment basics
- Supportive team care: orthopedics, ophthalmology, neurology and therapy
- Acyclovir if the newborn has active infection
- Airborne and contact precautions for active lesions
- VariZIG for exposed nonimmune pregnant women, and for newborns when mother's rash starts 5 days before to 2 days after delivery
- Prevention: varicella vaccine before pregnancy, never during it
Red flags
- Mother's chickenpox starts 5 days before to 2 days after delivery
- Newborn with blisters, fever or breathing trouble
- Seizures
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.