Abzug M J, Keyserling H L, Lee M L, Levin M J, Rotbart H A
Department of Pediatrics (Infectious Diseases), University of Colorado School of Medicine/Children's Hospital, Denver 80218, USA.
Clin Infect Dis. 1995 May;20(5):1201-6. doi: 10.1093/clinids/20.5.1201.
A prospective study of the virology of and serological responses to enterovirus infection in 16 neonates (< or = 2 weeks of life) and their mothers was performed. At study entry, 11 neonates did not have detectable serum neutralizing antibody to their own viral isolates, despite the presence of neutralizing antibody in 9 of 11 mothers of these infants. Viremia and viruria were demonstrated in 8 and 7 neonates, respectively, with maximal detected titers of 6.3 x 10(3) 50% tissue culture infective dose per mL (TCID50) and 6.8 x 10(1) TCID50/mL, respectively. Viremia was associated with onset of illness in the first 5 days of life, low initial serum neutralization titer, and the presence of echovirus serotypes. Randomized administration of intravenous immune globulin (IVIG; 750 mg/kg) to nine neonates overall modestly increased serum neutralization titers but did not reduce the daily incidence of viremia and viruria compared with that of controls. However, receipt of IVIG containing a neutralization titer of > or = 1:800 to the patients' own viral isolates was associated with significantly higher serum neutralization titers and more rapid cessation of viremia and viruria. Future trials of IVIG for neonatal enterovirus disease should assess the efficacy and safety of higher or repeated doses of this agent and/or of IVIG selected for their high titers to frequently circulating and/or particularly virulent enterovirus serotypes.
对16名新生儿（≤2周龄）及其母亲进行了一项关于肠道病毒感染的病毒学和血清学反应的前瞻性研究。在研究开始时，11名新生儿对其自身病毒分离株没有可检测到的血清中和抗体，尽管这些婴儿的11名母亲中有9名存在中和抗体。分别在8名和7名新生儿中检测到病毒血症和病毒尿，最大检测滴度分别为每毫升6.3×10³ 50%组织培养感染剂量（TCID50）和6.8×10¹ TCID50/mL。病毒血症与出生后前5天发病、初始血清中和滴度低以及存在回声病毒血清型有关。总体而言，对9名新生儿随机给予静脉注射免疫球蛋白（IVIG；750mg/kg）适度提高了血清中和滴度，但与对照组相比，并未降低病毒血症和病毒尿的每日发生率。然而，接受针对患者自身病毒分离株中和滴度≥1:800的IVIG与显著更高的血清中和滴度以及病毒血症和病毒尿更快停止有关。未来针对新生儿肠道病毒疾病的IVIG试验应评估更高剂量或重复剂量该药物和/或针对频繁循环和/或特别有毒力的肠道病毒血清型选择的高滴度IVIG的疗效和安全性。
