• Perform a general assessment to establish the neonate's risk of chickenpox, on the basis of the certainty of chickenpox in the contact and the level of exposure.
• If the neonate's mother is the contact, determine when, in relation to delivery, she developed chickenpox. If someone else is the contact, determine the age of the neonate at the time of contact.
• Seek urgent specialist advice regarding the need for testing and further management, and whether the mother should continue to breastfeed if she has chickenpox.
• All neonates with exposure from their mother, or elsewhere, must be followed up for 14–16 days by a GP, midwife, or health visitor, or in hospital. Monitor the infant for signs of infection for 14–16 days.

Recommendations regarding monitoring of an neonate who has been exposed to chickenpox are based on the Royal College of Obstetricians and Gynaecologists' guideline on Chickenpox in Pregnancy [RCOG, 2007], and a Drug and Therapeutics Bulletin [DTB, 2005a].

• CKS recommends seeking specialist advice in the management of a neonate who has been exposed to chickenpox or shingles because severe disease or complications can develop in this group. Depending on the time of exposure, there are a number of management strategies which may be undertaken in secondary care.
• Varicella-zoster immunoglobulin (VZIG) may not prevent chickenpox but is generally effective in reducing the severity of infection [Isaacs, 2000].
• The Health Protection Agency advises giving VZIG or intravenous aciclovir to the neonate depending on when the mother develops varicella in relation to delivery [HPA, 2007a]. This should only be done in a specialist setting.
• CKS advise seeking specialist advice regarding whether a mother with chickenpox should breastfeed in view of the potential complications for the baby and differing recommendations between organizations:
• Recommendations on breastfeeding from the Health Protection Agency guidance on the management of rash illness and exposure to rash illness in pregnancy state that: if the mother has chickenpox, she should be allowed to breastfeed. If lesions are close to the nipple, milk should be expressed from the affected side until lesions have crusted. This milk can be fed to the baby if he or she is covered by varicella-zoster immunoglobulin and/or aciclovir. These treatments should be initiated by a specialist [HPA, 2007a].
• The American Academy of Family Physicians recommends: babies born to mothers who develop chickenpox within 5 days antepartum or within 2 days postpartum are at risk for more serious chickenpox infections. It is recommended that baby and mother be separated until the mother is no longer infectious, but expressed breast milk may be supplied, as long as the milk does not come into contact with active lesions [Lawrence and Lawrence, 1999].