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Fifteen-minute consultation: Prevention and treatment of chickenpox in newborns
  1. Charlotte Holland1,
  2. Manish Sadarangani2,3
  1. 1 Department of Pediatrics, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
  2. 2 Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
  3. 3 Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Manish Sadarangani, Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC V5V 4L5, Canada; msadarangani{at}


There are inconsistencies in how newborns are managed following exposure to varicella, ranging from reassurance and observation to administration of varicella zoster immunoglobulin (VZIG) and admission to hospital for varying length courses of intravenous aciclovir.

Hospitalised preterm babies exposed to varicella should receive VZIG. Administration can otherwise be limited to pregnant non-immune women or to newborns if there is development of maternal chickenpox from 5 days prior to delivery up to 48 hours postdelivery. Intravenous aciclovir is only recommended in cases of newborn disease despite VZIG or in severe disease. The use of VZIG may not prevent varicella but may reduce severity of disease.

In this article, we review the evidence for risk to non-immune mothers, the fetus and newborns who had different types of exposure to varicella, with recommendations for management and treatment of confirmed neonatal chickenpox.

  • infectious diseases
  • congenital abnorm
  • general paediatrics
  • immunology
  • neonatology

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  • Contributors CH and MS conceived the idea for the article. CH wrote the first draft. Both authors reviewed the final version of the manuscript and approved for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MS is supported via salary awards from the BC Children’s Hospital Foundation, the Canadian Child Health Clinician Scientist Program and the Michael Smith Foundation for Health Research. MS has been an investigator on studies funded by Pfizer, Merck, VBI Vaccines and GSK. All funds have been paid to his institute, and he has not received any personal payments.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Patient consent for publication Not required.