VARIABLE CLINICAL COURSE OF NEONATAL VARICELLA. TWO CASE REPORTS

Purpose: To conduct a clinical and epidemiological analysis of neonatal varicella cases in the early neonatal period, to discuss clinical progression, complications, and formulate recommendations for practice. Materials/ Methods: A prospective study was conducted from 2023 to 2025 at the Infectious Diseases Clinic in Plovdiv, Bulgaria, involving hospitalized neonates diagnosed with neonatal varicella. The study used epidemiological analysis methods, as well as laboratory, microbiological, and imaging investigations. Results: This study describes two contrasting neonatal varicella cases with notably different clinical courses. The first case - a 13-day-old male, with severe presentation of the disease with systemic symptoms, including respiratory insufficiency and extensive rash, requiring intensive care and oxygen support. The second, a 12-day-old female, exhibited a milder course, uncomplicated progression with no systemic involvement. Both infants were exposed to maternal varicella infection during the peripartum period—a high-risk timeframe due to insufficient transfer to maternal antibodies through the placenta. Despite similar epidemiological factors, disease severity varied markedly. Conclusions: Neonatal varicella represents a considerable health risk, particularly in the context of late maternal infection. The clinical variability observed underscores the unpredictable course of the disease. Preventative strategies are key in reducing the risk. Though vaccination is not recommended during pregnancy, postpartum immunization of seronegative women and also post-exposure prophylaxis are essential measures to reduce neonatal morbidity and mortality.