A 3-day-old neonate born to a mother who had chickenpox 2 days before delivery presents with extensive vesicular skin rash, pneumonitis, and encephalitis. What is the most appropriate immediate treatment?
- A Oral acyclovir 20 mg/kg/dose 5 times daily
- B IV acyclovir 20 mg/kg/dose every 8 hours (60 mg/kg/day) ✓
- C VZIG (varicella-zoster immunoglobulin) alone
- D Ganciclovir IV
Correct answer: B. IV acyclovir 20 mg/kg/dose every 8 hours (60 mg/kg/day)
Explanation
Neonatal disseminated varicella (occurring when maternal infection is within 5 days before to 2 days after delivery) carries a 30% mortality risk and requires IV acyclovir 60 mg/kg/day divided every 8 hours (20 mg/kg/dose q8h) for at least 10 days. VZIG should have been given prophylactically but is insufficient once disseminated disease is established. Oral acyclovir is inadequate for severe neonatal varicella due to poor bioavailability.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.