Management of Exposed Newborns
Neonates infected with monkeypox (mpox) virus are thought to be at risk of severe disease. Infants born to individuals with confirmed or suspected mpox should undergo early bathing before vitamin K or vaccines are administered, or other procedures are performed. Post-exposure prophylaxis should be considered for exposed neonates in consultation with public health authorities. The optimal therapy for post-exposure prophylaxis of neonates is not known.
As of July 29, 2022, screening tests for evaluation of exposed, asymptomatic newborns are not available. Infants should be monitored for symptoms of mpox, including fever, lymphadenopathy, and rash. At a minimum, exposed infants should have daily temperature checks and complete skin exams. These can be performed by a caregiver or a healthcare provider. Exposed infants who develop a rash should undergo prompt testing for mpox.
Caregivers or family members who do not have suspected or confirmed mpox can provide routine care to an uninfected neonate who is born to a person with mpox. Separation of a newborn from an infected parent is recommended as the best way to prevent transmission.
The infected parent should be counseled about the risk of transmission and the potential for severe disease in newborns. If the parent chooses to have contact with the newborn during the infectious period, strict precautions should be taken, including the following:
- Avoid direct skin-to-skin contact.
- During contact the newborn should be fully clothed or swaddled and after contact occurs the clothing or blanket should be removed and replaced.
- Gloves and a fresh gown should be worn by the infected parent at all times, with all visible skin below the neck covered.
- Soiled linens should be removed from the area.
- The infected individual should wear a well-fitting source control (eg, medical mask) when in the same room as the newborn.
Precautions should be continued until criteria for discontinuing isolation have been met (ie, all lesions have resolved, the scabs have fallen off, and a fresh layer of intact skin has formed).
It is not yet known if mpox virus can be transmitted via breastmilk. Breastfeeding should be delayed and expressed breastmilk from a person who is infected or isolated should be discarded until the criteria for discontinuing isolation have been met.
Hospitalized neonates exposed to mpox should be isolated for the duration of the incubation period (21 days). Care should be provided in a private room and PPE used by healthcare providers should include gown, gloves, eye protection (ie, goggles or face shield), and a NIOSH-approved particulate respirator equipped with N95 filters or higher.
Discharge planning should take into account the duration of isolation, ability to strictly adhere to recommended isolation precautions, and availability of alternative caregivers.