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Discussion Starter · #1 ·
A 26-year-old woman who is 38 weeks pregnant presents to the emergency department (ED) in active labor. She has felt ill for the past 2 days and has been taking acetaminophen for fevers. Last night she broke out in an itchy rash that has spread over her arms and torso. She is a day care teacher, and 2 weeks prior a parent of one of the children in her class had called and informed the day care center that her child was diagnosed with chickenpox. She says she doesn’t remember if she had ever had chickenpox as a child. The patient wants to know what this means for her baby. What is the most correct advice to give this woman?
(A) “Nothing needs to be done; chickenpox in children and newborns is usually a mild, self-limiting illness”
(B) “The chance of transmitting the virus to your baby is low, so we will monitor the baby and treat if symptoms develop”
(C) “The varicella virus is teratogenic; therefore, your newborn may have some mild birth defects”
(D) “Your baby must be treated soon after birth because chickenpox is a serious illness in newborns”
(E) “Your baby will be protected because of your antibodies to the virus”
 

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Discussion Starter · #3 ·
Correct Answer

The correct answer is D. Varicella is a highly contagious virus that causes a potentially life threatening illness in newborns. The presentation is variable but can include fever, vesicular lesions, pneumonia, or meningitis. Newborns with mothers infected within 2 weeks of delivery are at greatest risk for complications, as maternal antibodies may not have been available to confer passive immunity to the infant. Patients should be treated with varicella-zoster immune globulin.

Answer A is incorrect. If untreated, chickenpox infection in newborns carries an approximately 30% mortality rate.

Answer B is incorrect. If untreated, chickenpox infection in newborns carries an approximately 30% mortality rate. Treatment with varicella-zoster immune globulin is started before symptoms develop for maximum efficacy.

Answer C is incorrect. Varicella infection during the first trimester can result in limb and digit defects, but the risk is small (approximately 1%).

Answer E is incorrect. If a woman develops symptoms from varicella virus (as this woman has), she will not have adequate antibodies against the virus in time to pass them on to the infant before delivery.
 

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Hi,

what do you think of this guys? It's from a website called "babycenter".

Is my baby at risk if I get chicken pox close to my due date?

If you get chicken pox early in the third trimester of pregnancy, your baby will probably be fine. Here's why: About five days after you come down with chicken pox, your body develops antibodies to the virus and passes them to your baby through the placenta, offering protection that his own immature immune system couldn't provide on its own.
If you develop chicken pox five to 21 days before your baby is born, he might develop chicken pox, but because of the antibodies he received from you, it's much less likely to be serious. (Some babies exposed to chicken pox in utero don't have any signs of infection at birth but develop a case of shingles during infancy or early childhood without having had chicken pox. Fortunately, it's usually not serious.)

The most risky time to come down with chicken pox is between five days before giving birth and two days after delivery, because then your baby is exposed to the virus but doesn't have time to receive antibodies from you. In this case, there's a high chance (estimated at 17 to 30 percent) that he'll develop what's called neonatal varicella, or newborn chicken pox, which can be serious and even life threatening - especially if left untreated.

Fortunately, your baby's risk of a severe case can be greatly reduced if he gets a shot of varicella zoster immune globulin (VZIG), a blood product that contains chicken pox antibodies. (You may also see this referred to as VariZIG, which is the brand name of the VZIG product that's currently available in the United States.) Your baby will be given the shot soon after birth if your chicken pox showed up within five days of delivery or as soon as you discover your rash if it's within two days after delivery.

If your newborn shows any sign of developing the infection - such as coming down with a fever or showing a rash of even a few spots - he'll be treated intravenously with the antiviral drug acyclovir.
 

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You should also know that VZIG is indicated and thus given only if a patient immune status is unknown or neg IgG titers, and high risk for the disease, because these are pts who are likely to develop complications from the disease.

According to NGC.gov. recomends in only these pt groups:-Immunosuppressed pts,pregnant pt, neonates whose mothers where exposed around time of delivery(5days prior and 2 days after delivery), neonates <28 wks regardless of mothers vaccination status,neonates >28 whose mothers have not been vaccinated

So correct answer is D.
 
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