Rubella is a typically mild childhood viral infection that may, however, have devastating consequences for fetuses and infants infected before birth.
Rubella is caused by a virus.
The fetus or newborn may have symptoms depending on when during the pregnancy infection occurred.
Blood tests and tests of other samples can be done to detect the virus in the fetus, newborn, or mother.
There is no specific treatment for the infection.
Vaccination before becoming pregnant can prevent the infection in the fetus.
(See also Overview of Infections in Newborns and Rubella in older children and adults.)
When a baby is born with rubella, the infection is called congenital rubella. In congenital rubella, a woman infected during the first 12 weeks of pregnancy passes the virus to the fetus through the placenta (the organ that provides nourishment to the fetus). This infection in the fetus can cause preterm birth, miscarriage, stillbirth, or multiple, severe birth defects. The earlier in pregnancy the infection occurs, the greater the risk of severe abnormalities.
Congenital rubella is rare in the United States because rubella vaccination has become routine.
Symptoms of Rubella in Newborns
Depending on when during the pregnancy the fetus is infected, the fetus may have no symptoms or may be stillborn.
Infants who survive may have multiple birth defects. These birth defects are referred to as congenital rubella syndrome (CRS).
The most common symptoms of congenital rubella syndrome in newborns include
Low birth weight
Brain inflammation
Damage to the retina (the transparent, light-sensitive structure at the back of the eye)
Enlarged liver and spleen
Decreased bone density
Less common symptoms include bruises or other skin spots and enlarged lymph nodes.
Diagnosis of Rubella in Newborns
Tests to measure antibody levels in a pregnant person's blood
Tests of the amniotic fluid or blood in the fetus
Tests to measure antibody levels and to look for the virus in the newborn
Pregnant people are routinely screened with a blood test early in pregnancy to determine whether they have antibodies to rubella. If antibodies to rubella are found in their blood, they are considered immune. If antibodies are not found, they are not immune. The test is repeated in pregnant people who develop symptoms of rubella. Doctors also test throat, nose, or urine samples to determine whether a pregnant person has rubella virus.
Fetuses can be diagnosed before birth by testing the amniotic fluid or their blood.
Newborns suspected of having congenital rubella syndrome should have blood tests to measure antibody levels, and specimens may be taken and tested to look for the virus.
Other tests in the newborn may include a spinal tap and x-rays of the bones to look for abnormalities caused by congenital rubella syndrome. Newborns should also be given thorough eye and heart examinations.
Treatment of Rubella in Newborns
Support for affected children
No specific treatment is available.
Support and care for a newborn who has congenital rubella syndrome vary depending on the extent of the newborn's problems. Children who have multiple complications require early treatment from a team of specialists.
Prevention of Rubella in Newborns
Rubella can be prevented by vaccination. In the United States, infants should receive a combined measles, mumps, and rubella (MMR) vaccine. The first dose is given at 12 to 15 months of age and the second dose is given at 4 to 6 years of age. (See also Childhood Vaccination Schedules.)
People who can become pregnant (but are not currently pregnant) who are not immune to rubella (based on a blood test) or have never received the MMR vaccine should receive at least 1 dose of the MMR vaccine. After vaccination, people should not become pregnant for 28 days because of potential harm to a fetus.
Pregnant people who are not immune to rubella should avoid anyone who has rubella and then be given the vaccine immediately after giving birth so that they will be immune during any future pregnancies. People cannot be vaccinated during pregnancy because the vaccine contains living virus that might infect the fetus. Because of this risk, all people who are capable of becoming pregnant who receive the rubella vaccine should make sure they do not become pregnant for at least 28 days after vaccination.
