From the Guidelines
Children with varicella should be admitted to the hospital when they are under 1 year of age, have severe immuno-compromising conditions, or develop serious complications such as pneumonia, skin and soft tissue infections, dehydration, or encephalitis. Admission is warranted for patients with risk factors for severe disease, including infants aged <1 year, who are six times more likely to be hospitalized than children aged 5--9 years 1. Children who are immunocompromised or have severe symptoms such as respiratory distress, hypoxemia, or signs of sepsis should also be considered for admission 1. Treatment typically includes supportive care, and close monitoring of respiratory status, skin lesions for secondary bacterial infections, and neurological function is essential during hospitalization. Key considerations for admission include:
- Age under 1 year
- Severe immuno-compromising conditions
- Respiratory complications like pneumonia
- Severe skin infections
- Dehydration
- Encephalitis
- Signs of sepsis
- Inability to take oral medications or fluids
- Severe pain or failure of outpatient management. Early intervention and hospitalization can significantly reduce morbidity, mortality, and improve quality of life for high-risk patients with varicella 1.
From the Research
Admission Criteria for Children with Varicella
When considering the admission of a child with varicella, several factors should be taken into account. These include:
- The presence of complications such as Staphylococcus aureus infections, otitis media, endocarditis, pneumonia, and central nervous system (CNS) events like cerebellar ataxia and encephalitis 2
- The child's immune status, with immunocompromised children being at higher risk for severe varicella infections 3, 4
- The presence of underlying medical conditions, such as chronic cutaneous or pulmonary disorders, or those receiving long-term salicylate therapy 5
- The severity of symptoms, including the presence of fever, new lesions, and internal organ involvement 4
High-Risk Groups
Certain groups of children are at increased risk for severe varicella or its complications and may require admission, including:
- Immunocompromised children 3, 4, 6
- Children with underlying medical conditions, such as chronic cutaneous or pulmonary disorders 5
- Children older than 12 months with a chronic cutaneous or pulmonary disorder and those receiving long-term salicylate therapy 5
- Otherwise healthy, nonpregnant individuals 13 years of age or older 5
Treatment and Management
The treatment and management of varicella in children may involve:
- Antiviral therapy, such as acyclovir, which can reduce the severity and duration of symptoms 3, 5, 4
- Hospitalization, particularly for immunocompromised children or those with severe symptoms 2, 4, 6
- Sequential use of intravenous and oral acyclovir in immunocompromised children 4
- Supportive care, including inotropic support and invasive ventilation, for children with severe symptoms or complications 6