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Fetal varicella syndrome — Clinical Guidelines

Overview

Fetal varicella syndrome (FVS) is a rare condition affecting newborns resulting from maternal varicella-zoster virus (VZV) infection during early pregnancy, leading to cutaneous scars, limb defects, and abnormalities in the ocular and central nervous systems 4.

Diagnosis

Key Diagnostic Criteria: Cutaneous scars, limb defects, ocular abnormalities, and central nervous system dysfunction 4.

Recommended Tests: Prenatal diagnosis through maternal serology and clinical history; postnatal evaluation includes physical examination and imaging studies to assess neurological and skeletal involvement 4.

Management

Supportive Care: Focus on managing symptoms and providing multidisciplinary support including physical therapy, ophthalmology care, and neurology consultations as needed 4.

No Specific Antiviral Treatment Mentioned: No specific antiviral treatments are highlighted in the provided abstracts for FVS management 4.

Special Populations

Pregnancy: Maternal varicella infection during early pregnancy poses significant risk; prevention through vaccination or early treatment post-exposure is crucial 4.

Pediatrics: Long-term follow-up is essential for managing developmental delays and physical anomalies 4.

Key Recommendations

Prenatal Prevention: Vaccinate women of childbearing age against varicella to prevent maternal infection during pregnancy (Evidence: Expert opinion 4).

Early Post-Exposure Management: Prompt treatment of maternal varicella infection with antiviral therapy to minimize fetal exposure (Evidence: Expert opinion 4).

Comprehensive Postnatal Care: Ensure newborns exposed in utero receive thorough physical and neurological evaluations and appropriate multidisciplinary support (Evidence: Expert opinion 4).

References

1 . Counting the costs of drinking alcohol during pregnancy. Bulletin of the World Health Organization 2017. link 2 Priaulx N. Pre(natal) crime: pregnant women, substance abuse and the law. The Medico-legal journal 2015. link 3 Naseer MI, Ullah N, Ullah I, Koh PO, Lee HY, Park MS et al.. Vitamin C protects against ethanol and PTZ-induced apoptotic neurodegeneration in prenatal rat hippocampal neurons. Synapse (New York, N.Y.) 2011. link 4 Ramachandra S, Metta AK, Haneef NS, Kodali S. Fetal varicella syndrome. Indian journal of dermatology, venereology and leprology 2010. link 5 Elliott EJ, Bower C. Alcohol and pregnancy: the pivotal role of the obstetrician. The Australian & New Zealand journal of obstetrics & gynaecology 2008. link 6 Kulkarni ML, Zaheeruddin M, Shenoy N, Vani HN. Fetal valproate syndrome. Indian journal of pediatrics 2006. link 7 Kim YM, Romero R, Chaiworapongsa T, Espinoza J, Mor G, Kim CJ. Dermatitis as a component of the fetal inflammatory response syndrome is associated with activation of Toll-like receptors in epidermal keratinocytes. Histopathology 2006. link 8 Morrison DG, Elsas FJ, Descartes M. Congenital oculomotor nerve synkinesis associated with fetal retinoid syndrome. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 2005. link 9 Sathienkijkanchai A, Wasant P. Fetal warfarin syndrome. Journal of the Medical Association of Thailand = Chotmaihet thangphaet 2005. link 10 De Smet L, Debeer P. Fetal hydantoin syndrome with unilateral atypical cleft hand: additional evidence for vascular disruption. Genetic counseling (Geneva, Switzerland) 2002. link 11 Shah MK, Morava E, Gill W, Marble MR. Transposition of the great arteries and hypocalcemia in a patient with fetal hydantoin syndrome. Journal of perinatology : official journal of the California Perinatal Association 2002. link 12 Diekman ST, Floyd RL, Découflé P, Schulkin J, Ebrahim SH, Sokol RJ. A survey of obstetrician-gynecologists on their patients' alcohol use during pregnancy. Obstetrics and gynecology 2000. link00616-x) 13 Conrad C. Physician awareness and screening for fetal alcohol syndrome. Journal of health and human services administration 2000. link 14 Abel EL, Kruger M. What do physicians know and say about fetal alcohol syndrome: a survey of obstetricians, pediatricians, and family medicine physicians. Alcoholism, clinical and experimental research 1998. link 15 DiLiberti JH, Farndon PA, Dennis NR, Curry CJ. The fetal valproate syndrome. American journal of medical genetics 1984. link 16 Weinberg J. Nutritional issues in perinatal alcohol exposure. Neurobehavioral toxicology and teratology 1984. link 17 Little RE, Streissguth AP, Guzinski GM, Grathwohl HL, Blumhagen JM, McIntyre CE. Change in obstetrician advice following a two-year community educational program on alcohol use and pregnancy. American journal of obstetrics and gynecology 1983. link90921-3) 18 Weiner L, Rosett HL, Edelin KC. Behavioral evaluation of fetal alcohol education for physicians. Alcoholism, clinical and experimental research 1982. link 19 Landesman-Dwyer S, Keller LS, Streissguth AP. Naturalistic observations of newborns: effects of maternal alcohol intake. Alcoholism, clinical and experimental research 1978. link 20 Streissguth AP, Herman CS, Smith DW. Stability of intelligence in the fetal alcohol syndrome: a preliminary report. Alcoholism, clinical and experimental research 1978. link 21 Tillner I, Majewski F. Furrows and dermal ridges of the hand in patients with alcohol embryopathy. Human genetics 1978. link 22 Wallar PH, Genstler DE, George CC. Multiple systemic and periocular malformations associated with the fetal hydantoin syndrome. Annals of ophthalmology 1978. link 23 Hanson JW, Streissguth AP, Smith DW. The effects of moderate alcohol consumption during pregnancy on fetal growth and morphogenesis. The Journal of pediatrics 1978. link80449-1) 24 Streissguth AP. Maternal drinking and the outcome of pregnancy: implications for child mental health. The American journal of orthopsychiatry 1977. link 25 Hanson JW. Alcohol and the fetus. British journal of hospital medicine 1977. link 26 Merten DF, Goetzman BW, Wennberg RP. Persistent fetal circulation: an evolving clinical and radiographic concept of pulmonary hypertension of the newborn. Pediatric radiology 1977. link 27 Mulvihill JJ, Klimas JT, Stokes DC, Risemberg HM. Fetal alcohol syndrome: seven new cases. American journal of obstetrics and gynecology 1976. link90492-0) 28 Hanson JW, Jones KL, Smith DW. Fetal alcohol syndrome. Experience with 41 patients. JAMA 1976. link 29 Christoffel KK, Salafsky I. Fetal alcohol syndrome in dizygotic twins. The Journal of pediatrics 1975. link80919-x)

Fetal varicella syndrome