A maternal varicella infection in the last 4 weeks of a woman’s pregnancy poses a high risk of varicella infection of the new born. If there are no other risks for mother and baby, the delivery should be postponed for at least 7 days after the onset of the maternal rash to allow for the passive transfer of antibodies from mother to child.
Severe chickenpox is most likely to occur if the infant is born within 5 days of onset of the mother’s rash or if the mother develops the rash up to 2 days after delivery. For babies born to mothers who have had chickenpox within the period 5 days before to 2 days after delivery, it is therefore vital that the neonate receives prophylaxis as soon as possible with VZIG with or without acyclovir; irrespective breastfeeding or not.
Irrespective of day of onset of chickenpox rash in mothers, they can breastfeed if they are well enough to do so. If there are active chickenpox lesions close to the nipple, they should express breast milk from the affected breast until the lesions have crusted over. The expressed breast milk may be fed to the baby.
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