Pediatric Rubella Treatment & Management

Updated: Feb 09, 2017
  • Author: Elias Ezike, MD; Chief Editor: Russell W Steele, MD  more...
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Treatment

Medical Care

Postnatal rubella

Treatment is supportive. No specific antiviral agent for rubella is currently available.

Starch baths and antihistamines may be useful for adult patients with uncomplicated rubella and troublesome itching.

For complicated cases, treatment is as follows:

  • For severe arthritis affecting weight-bearing joints, encourage rest. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful, but corticosteroids are not indicated.
  • For patients with encephalitis, provide supportive care with adequate fluid and electrolyte maintenance.
  • Thrombocytopenia is usually self-limited but, if severe, consider intravenous immunoglobulin (IVIG). Corticosteroids have not demonstrated any specific benefit. Splenectomy is not indicated.

Congenital rubella syndrome

Treatment is supportive. Provide vision screening and hearing screening for asymptomatic newborns.

Treatment of symptomatic newborns is as follows:

  • Provide careful evaluation of the eyes and ophthalmology referral for babies with corneal clouding, cataract, and retinopathy. Corneal clouding may indicate infantile glaucoma.
  • Babies with congenital rubella syndrome who develop respiratory distress may require supportive treatment in the ICU.
  • Hepatosplenomegaly is monitored clinically. No intervention is required.
  • Patients with hyperbilirubinemia may require phototherapy or exchange transfusions if jaundice is severe to prevent kernicterus.
  • True hemorrhagic difficulties have not been a major problem; however, IVIG may be considered in infants who develop severe thrombocytopenia. Corticosteroids are not indicated.
  • Infants who have a rubella-related heart abnormality should be carefully observed for signs of congestive heart failure. Echocardiography may be essential for diagnosis of heart defects.

Contact isolation is required for patients with congenital rubella during hospitalizations because babies are infected at birth and are usually contagious until older than 1 year unless viral cultures have produced negative results.

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Surgical Care

Postnatal rubella

Surgical care is not indicated.

Congenital rubella syndrome

Surgical treatment may be required for congenital heart anomalies, including patent ductus arteriosus (PDA), coarctation of aorta, ventricular septal defect (VSD), atrial septal defect (ASD), and pulmonary artery stenosis.

Surgical treatment may be required for eye defects such as glaucoma, cataract, and retinal neovascularization.

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Consultations

Infectious disease specialist

Consult an infectious disease specialist for complicated postnatal rubella and congenital rubella syndrome.

Otolaryngologist

Audiometric testing and other hearing screening tests are necessary to promptly diagnose hearing loss in children who may benefit from proper educational programs.

Cardiologist and cardiothoracic surgeon

Children with congenital heart diseases require cardiology referral and echocardiography for adequate management. Lifesaving cardiac repair may be necessary.

Ophthalmologist

An ophthalmologic evaluation and follow-up care are necessary in children with ocular abnormalities. Glaucoma, cataract, and retinal neovascularization may require surgical intervention.

Neurologist

A neurologic evaluation and follow-up care are needed for children who have CNS anomalies, including motor weakness and delay, poor balance, mental retardation, behavioral abnormalities, and learning deficits.

Rehabilitation specialist

Adequate rehabilitation programs comprising physical and occupational therapy may be beneficial for patients with motor weakness and motor delay.

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Diet

Diet is as tolerated.

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Activity

Activity in rubella can be maintained as tolerated; however, rest is advised for patients who develop arthralgia or arthritis.

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