What are the complications and management of neonatal mumps?

Complications and Management of Neonatal Mumps

Neonatal mumps is a rare but potentially serious condition that can cause severe respiratory distress, thrombocytopenia, and persistent pulmonary hypertension requiring aggressive supportive care and close monitoring.

Complications of Neonatal Mumps

Neonatal mumps presents differently from mumps in older children and adults, with several unique complications:

Respiratory Complications

• Severe respiratory distress due to interstitial pneumonia 1
• Persistent pulmonary hypertension requiring mechanical ventilation 2
• Pulmonary hemorrhage requiring artificial surfactant administration 2
• Laryngeal edema (rare but potentially life-threatening) 3

Hematological Complications

• Thrombocytopenia which may be severe 4
• Splenomegaly 4

Other Complications

• Fever without the classic parotitis seen in older children and adults 4
• Potential for aseptic meningitis (occurs in up to 15% of mumps cases generally) 5

Management of Neonatal Mumps

Respiratory Support

• High-frequency oscillation ventilation for severe respiratory distress 2
• Artificial surfactant administration for pulmonary complications 2
• Airway management including potential intubation for laryngeal edema 3
• Supplemental oxygen as needed

Supportive Care

• Fever management with appropriate antipyretics
• Hydration to maintain fluid balance
• Isolation precautions to prevent spread to other neonates 6

Monitoring

• Continuous cardiorespiratory monitoring
• Regular complete blood counts to monitor thrombocytopenia
• Neurological assessments to detect signs of aseptic meningitis

Infection Control

• Droplet precautions for exposed infants 6
• Cohorting and isolation of exposed infants 6
• Healthcare worker vaccination to prevent nosocomial spread 6

Prevention

Prevention is critical since there is no specific antiviral therapy for mumps:

• MMR vaccination of susceptible healthcare workers 5, 6
• Immunological assessment of pregnant women after exposure 4
• Isolation of infected individuals for at least 5 days after onset of parotitis 6

Special Considerations

• Unlike mumps in adults, neonates often do not present with parotitis 4
• Maternal mumps infection during pregnancy, particularly in the first trimester, carries an increased risk of fetal death 5
• Congenital mumps can occur when the mother develops mumps shortly before delivery 1, 2

Clinical Pearls and Pitfalls

• Pitfall: Failing to consider mumps in neonates with respiratory distress without parotitis
• Pearl: Consider mumps in neonates with unexplained respiratory distress, especially with maternal history of recent mumps-like illness
• Pitfall: Delaying respiratory support in rapidly progressing cases
• Pearl: Aggressive airway management may be necessary to prevent mortality 1, 3

Early recognition and aggressive supportive care are essential for managing the potentially life-threatening complications of neonatal mumps.