Monkeypox in neonates: A narrative review on clinical presentations, vertical transmission, and treatment challenges

Table 1 Comparing Monkeypox to other neonatal infections

Feature	Monkeypox	Congenital varicella	Neonatal HSV	Bacterial sepsis
Agent	Orthopoxvirus (MPXV)	Herpesvirus (VZV)	Herpesvirus (HSV1/2)	Various bacteria (e.g., Escherichia coli)
Incubation	5-21 days	10-21 days	About 5-21 days	Hours-days
Rash	Deep, firm pustules in synchronous stages	Superficial vesicles at mixed stages	Grouped vesicles, may ulcerate	Often absent or nonspecific
Mode of transmission	Close contact; perinatal/vertical	Transplacental or perinatal	Transplacental; peripartum/postnatal	Vertical, nosocomial
Key lab	PCR for MPXV DNA	PCR/DFA for VZV	PCR for HSV	Blood/CSF cultures
Treatment	Supportive; tecovirimat	Acyclovir	Acyclovir	Empiric broadspectrum antibiotics
Prognosis	Variable, better in supportive care	Risk of mortality/morbidity	Poor if untreated, improved with early therapy	Depends on pathogen and prompt treatment

PCR: Polymerase chain reaction; MPXV: Monkeypox virus; DFA: Direct fluorescent antibody; VZV: Varicella-zoster virus; HSV: Herpes simplex virus; CSF: Cerebrospinal fluid; CBF: Cerebral blood flow.