Chickenpox is often considered more severe during the first year of life, but its course is usually mild during the first 3 months of life, presumably owing to the persistence of maternal
antibodies. Hospitalization and intravenous
acyclovir therapy are generally restricted to severe cases but also systematically recommended in newborns in France, irrespective of the clinical severity of the
infection. This recommendation was launched in 1998 when Varicella zoster virus (VZV)-specific
immunoglobulins were not available in the country and has remained unchanged since. The aim of this prospective observational study was to describe complications of
varicella infection in a population of 745 children hospitalized for
varicella before 1 year of age, with a specific focus on newborns. Complications occurred in 65% of cases. They were very rare before the age of 1 month (10%) but their incidence then increased progressively with age and probably the disappearance of maternal
antibodies: 42% (1-2 months), 66% (3-5 months), 70% (6-8 months), and 79% (9-12 months). Conclusion
Chickenpox is usually mild in newborns because most of them are protected by VZV maternal
antibodies. Unless the absence of maternal VZV immunity is demonstrated, newborns with mild
chickenpox should not require
antiviral therapy.