Ikram E, Shaukat A, Qureshi MS, Saifullah M, Aslam MA, Mehdi AM. Monkeypox in neonates: A narrative review on clinical presentations, vertical transmission, and treatment challenges. World J Clin Infect Dis 2025; 14(1): 109806 [DOI: 10.5495/wjcid.v14.i1.109806]
Corresponding Author of This Article
Abbas Muhammad Mehdi, MD, Department of Medicine, International School of Medicine International University of Kyrgyzstan, 6 Seven April Street, Bishkek 720065, Kyrgyzstan. malikmehdi0508@gmail.com
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Infect Dis. Jul 25, 2025; 14(1): 109806 Published online Jul 25, 2025. doi: 10.5495/wjcid.v14.i1.109806
Monkeypox in neonates: A narrative review on clinical presentations, vertical transmission, and treatment challenges
Ezza Ikram, Abaidullah Shaukat, Muhammad Shoaib Qureshi, Muneeb Saifullah, M Afaq Aslam, Abbas Muhammad Mehdi
Ezza Ikram, Abaidullah Shaukat, M Afaq Aslam, Department of Medicine, Quaid-e-Azam Medical College, Bahawalpur, Bhawana 63100, Punjab, Pakistan
Muhammad Shoaib Qureshi, Muneeb Saifullah, Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Abbas Muhammad Mehdi, Department of Medicine, International School of Medicine International University of Kyrgyzstan, Bishkek 720065, Kyrgyzstan
Author contributions: Ikram E and Shaukat A conceived and revised the manuscript; Qureshi MS, Saifullah M, Aslam MA and Mehdi AM wrote and reviewed the manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abbas Muhammad Mehdi, MD, Department of Medicine, International School of Medicine International University of Kyrgyzstan, 6 Seven April Street, Bishkek 720065, Kyrgyzstan. malikmehdi0508@gmail.com
Received: May 22, 2025 Revised: June 14, 2025 Accepted: July 9, 2025 Published online: July 25, 2025 Processing time: 63 Days and 10.2 Hours
Abstract
Monkeypox (Mpox), a zoonotic infection caused by the Mpox virus, has re-emerged as a global public health concern, with unique implications for neonatal health. Although rare in newborns, cases of neonatal Mpox pose significant diagnostic and therapeutic challenges due to limited clinical data and the vulnerability of this population. This narrative review explores the pathophysiology, clinical presentation, diagnostic barriers, and therapeutic strategies associated with Mpox in neonates. Vertical and perinatal transmission have been identified, with some cases presenting with vesicular rashes, fever, lymphadenopathy, and systemic involvement such as respiratory or neurological complications. Diagnosis often relies on polymerase chain reaction testing, yet resource limitations and symptom overlap with other neonatal infections can hinder accurate identification. Antiviral treatments like tecovirimat and cidofovir are considered in severe cases, but dosing in neonates remains uncertain due to a lack of robust safety data. Supportive care, including hydration, fever management, and prevention of secondary infections, is critical. Breastfeeding decisions require individualized assessment due to the unknown risk of viral transmission through breast milk. Preventive strategies emphasize early isolation, surveillance, and infection control measures in neonatal care settings. The review highlights significant research gaps in understanding neonatal Mpox, especially concerning long-term outcomes and optimal treatment protocols. A coordinated global effort is essential to improve diagnostics, develop safe therapeutic options, and establish evidence-based guidelines tailored to neonates.
Core Tip: Neonatal Monkeypox, though rare, presents significant diagnostic and therapeutic challenges due to limited data and clinical overlap with other infections. Vertical and perinatal transmission pathways raise concerns for early-life vulnerability. This review highlights the urgent need for age-specific antiviral protocols and evidence-based guidelines for neonatal management.
