A neonate is born at 35 weeks gestation to a mother who developed varicella zoster rash 4 days before delivery. The neonate appears well. What is the MOST appropriate management?
- A Administer varicella zoster immunoglobulin (VZIG) to the neonate immediately ✓
- B Start intravenous acyclovir prophylaxis in the neonate
- C Vaccinate the neonate with varicella vaccine within 72 hours
- D No intervention is required as maternal antibodies are protective
Correct answer: A. Administer varicella zoster immunoglobulin (VZIG) to the neonate immediately
Explanation
When maternal varicella onset is between 5 days before and 2 days after delivery, the neonate is at highest risk for severe or fatal neonatal varicella because there is insufficient time for maternal antibody transfer. VZIG should be given immediately to the neonate. Acyclovir is reserved for neonates who develop clinical varicella.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.