{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:11:48Z","timestamp":1783350708292,"version":"3.54.6"},"reference-count":22,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Chicken pox is a rare but serious condition in neonates\u2014often regarded as a common childhood illness with mild symptoms\u2014yet it can lead to severe complications, especially in the perinatal period. Neonatal varicella may present with fever occurring within the first 5\u201310 days of life, followed by a generalized vesicular eruption. The syndrome is uncommon, largely due to the widespread immunity in women of childbearing age, acquired through prior chicken pox infection or varicella immunization. However in Indonesia, a developing country without a national mandatory varicella vaccination program, the disease burden remains significant, and cases of neonatal varicella are still encountered. Neonates are at high risk of severe varicella infection, which, if untreated, has a reported mortality rate of up to 30%. Although varicella is rare in neonates, there are limited studies that have reported it. This study highlights the clinical presentations upon admission, diagnostic investigations, therapeutic management strategies, and potential complications of neonatal varicella. Methods: This study presents two cases of neonatal varicella that were managed at Hasan Sadikin General Hospital in West Java, Indonesia. Each patient underwent a clinical assessment and diagnostic evaluation upon arrival, followed by therapeutic management strategies, including the management of any complications that emerged during treatment. Results: The two cases of neonates presented with classic clinical features of neonatal varicella, including a generalized vesicular rash followed by fever within the first 10 to 12 days of life, without dermatological lesions or congenital malformations at birth. In both cases, maternal chicken pox developed within the first few days postpartum, suggesting postnatal transmission as the likely source of infection. Complications observed included respiratory failure and pneumonia, requiring respiratory support. However, both neonates recovered successfully without the administration of IVIG. Conclusions: Early initiation of antiviral therapy, timely administration of antibiotics, comprehensive supportive care, and monitoring for potential complications play a crucial role in managing neonatal varicella, even in the absence of IVIG.<\/jats:p>","DOI":"10.3390\/children12081081","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T07:53:12Z","timestamp":1755503592000},"page":"1081","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Managing Neonatal Varicella: A Case Series Highlighting the Effectiveness of Antiviral Therapy Without IVIG"],"prefix":"10.3390","volume":"12","author":[{"given":"Filla Reviyani","family":"Suryaningrat","sequence":"first","affiliation":[{"name":"Department of Child Health, Faculty of Medicine, Universitas Padjajaran, Dr Hasan Sadikin General Hospital, Bandung 40161, West Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sindy","family":"Irenewati","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universitas Diponegoro, Semarang 50244, Central Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devatri","family":"Hudayari","sequence":"additional","affiliation":[{"name":"Department of Child Health, Faculty of Medicine, Universitas Padjajaran, Dr Hasan Sadikin General Hospital, Bandung 40161, West Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5789-6010","authenticated-orcid":false,"given":"Fiva Aprilia","family":"Kadi","sequence":"additional","affiliation":[{"name":"Department of Child Health, Faculty of Medicine, Universitas Padjajaran, Dr Hasan Sadikin General Hospital, Bandung 40161, West Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aris","family":"Primadi","sequence":"additional","affiliation":[{"name":"Department of Child Health, Faculty of Medicine, Universitas Padjajaran, Dr Hasan Sadikin General Hospital, Bandung 40161, West Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetty","family":"Yuniati","sequence":"additional","affiliation":[{"name":"Department of Child Health, Faculty of Medicine, Universitas Padjajaran, Dr Hasan Sadikin General Hospital, Bandung 40161, West Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,18]]},"reference":[{"key":"ref_1","unstructured":"Saleh, H.M., and Kumar, S. (2025, June 15). Varicella-Zoster Virus (Chickenpox), StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK448191\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1080\/14760584.2017.1343669","article-title":"Varicella vaccination\u2014The global experience","volume":"16","author":"Wutzler","year":"2017","journal-title":"Expert Rev. Vaccines"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"278","DOI":"10.5005\/jp-journals-11002-0040","article-title":"Congenital and Perinatal Varicella Infections","volume":"1","author":"Maheshwari","year":"2022","journal-title":"Newborn"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Ion, A., Orzan, O.A., and B\u0103l\u0103ceanu-Gur\u0103u, B. (2025). Varicella Zoster Virus Infection and Pregnancy: An Optimal Management Approach. 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Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e9649","DOI":"10.1002\/ccr3.9649","article-title":"Neonatal Varicella, Treated with Oral Acyclovir: A Rare and Challenging Case Report in a Limited-Resource Country Like Cambodia","volume":"12","author":"Chap","year":"2024","journal-title":"Clin. Case Rep."},{"key":"ref_13","first-page":"CD011503","article-title":"Valacyclovir versus acyclovir for the treatment of herpes zoster ophthalmicus in immunocompetent patients","volume":"2016","author":"Schuster","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_14","unstructured":"Peechakara, B.V., and Gupta, M. (2025, August 06). 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Rev."},{"key":"ref_21","first-page":"6111","article-title":"Clinical Pharmacology of Cefotaxime in Neonates and Infants: Effects and Pharmacokinetics","volume":"5","author":"Pacifici","year":"2017","journal-title":"Int. J. Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2344","DOI":"10.1016\/j.clnu.2018.06.948","article-title":"ESPGHAN\/ESPEN\/ESPR\/CSPEN guidelines on pediatric parenteral nutrition: Fluid and electrolytes","volume":"37","author":"Jochum","year":"2018","journal-title":"Clin. Nutr."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/8\/1081\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:29:39Z","timestamp":1760034579000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/8\/1081"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,18]]},"references-count":22,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["children12081081"],"URL":"https:\/\/doi.org\/10.3390\/children12081081","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,18]]}}}