van Der Zwet Wil C, Vandenbroucke-Grauls Christina M J E, van Elburg Ruurd M, Cranendonk Anneke, Zaaijer Hans L
Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, the Netherlands.
Pediatrics. 2002 Jan;109(1):79-85. doi: 10.1542/peds.109.1.79.
Varicella-zoster virus (VZV) can cause severe disease in premature neonates. The fetus receives protective maternal VZV-immunoglobulin G (IgG) mainly in the third trimester of pregnancy. Therefore, premature neonates are considered at risk for VZV infection. Administration of varicella-zoster immunoglobulin (VZIG) within 96 hours after exposure effectively prevents severe illness in susceptible patients. The objectives of this study were to define the major determinants of the neonatal VZV-IgG titer and to determine the half-life of transplacentally acquired VZV-IgG. Guidelines provided by the Centers for Disease Control and Prevention for the use of VZIG in (premature) neonates were evaluated.
VZV-IgG titers were measured in sera of 221 neonates and 43 mothers using a quantitative enzyme-linked immunosorbent assay. In 27 neonates, VZV-IgG titers were followed for up to 14 weeks.
In a linear regression model, the maternal antibody titer was the major determinant of the neonatal titer (beta = 0.89); gestational age was only of minor importance (beta = 0.18). The median half-life of VZV-IgG in neonates was 25.5 days (range: 14.6-76.0 days). In the first weeks of life, major fluctuations of the VZV-IgG titer occurred in >50% of the neonates. The predictive value of Centers for Disease Control and Prevention guidelines for identification of neonates who should receive VZIG in case of exposure to VZV was poor: positive and negative predictive values were 0.80 and 0.43, respectively.
The neonatal VZV-IgG titer is predominantly predicted by the maternal VZV-IgG titer, whereas birth weight and gestational age are much less predictive than previously reported.
水痘带状疱疹病毒（VZV）可导致早产新生儿患严重疾病。胎儿主要在妊娠晚期获得母体的保护性水痘带状疱疹免疫球蛋白G（IgG）。因此，早产新生儿被认为有感染VZV的风险。暴露后96小时内给予水痘带状疱疹免疫球蛋白（VZIG）可有效预防易感患者患严重疾病。本研究的目的是确定新生儿VZV-IgG滴度的主要决定因素，并确定经胎盘获得的VZV-IgG的半衰期。对疾病控制和预防中心关于在（早产）新生儿中使用VZIG的指南进行了评估。
使用定量酶联免疫吸附测定法检测221例新生儿和43例母亲血清中的VZV-IgG滴度。对27例新生儿的VZV-IgG滴度进行了长达14周的随访。
在一个线性回归模型中，母体抗体滴度是新生儿滴度的主要决定因素（β=0.89）；胎龄的重要性较小（β=0.18）。新生儿VZV-IgG的中位半衰期为25.5天（范围：14.6 - 76.0天）。在生命的最初几周，超过50%的新生儿VZV-IgG滴度出现大幅波动。疾病控制和预防中心指南对识别暴露于VZV时应接受VZIG的新生儿的预测价值较差：阳性预测值和阴性预测值分别为0.80和0.43。
新生儿VZV-IgG滴度主要由母体VZV-IgG滴度预测，而出生体重和胎龄的预测性远低于先前报道。
