Overview of Neonatal Lupus

Benay Johnson, MSN, RN, CPNP, NNP-BC

Disclosures

J Pediatr Health Care. 2014;28(4):331-341. 

In This Article

Role of the Neonatal Practitioner

Whether the neonatal practitioner practices in the outpatient pediatric setting, newborn nursery, or neonatal intensive care, he or she has a role that can lead to the discovery of NL. Diagnosis may be presumptive in a newborn who presents with or acquires a cutaneous rash of unknown origin. If the mother has a history of an autoimmune disorder, it should be ascertained if she has undergone screening for anti–SS-A/Ro, anti–SS-B/La, anti-dsDNA, and ANA or RNP. If serial fetal echocardiogram studies were performed, it would be important to note the results. Mothers with long-term autoimmune disease also may have a compromised renal system, leading to uteroplacental insufficiency as a result of chronic hypertension or pregnancy-induced hypertension. Preparations need to be made in the delivery room to treat a baby that is premature, small for gestational age (Sawalha et al., 2006), and possibly in respiratory and cardiac arrest. Once delivered, whether CHB was detected prenatally or not, the newborn should be screened with an echocardiogram and electrocardiogram with follow-up cardiology consultation.

Cutaneous lesions may not appear until the baby has been discharged home and may not present until 4 to 6 weeks of age (Silverman & Jaeggi, 2010). It is important to carefully evaluate each rash in association with an in-depth physical examination and maternal history. Low-potency topical steroids are described as a method to assist in the eradication the NL rash (Hoath & Narendran, 2011); however, topical steroid treatments can diminish the rash and mask cutaneous manifestations of lupus in the neonate.

With or without a positive maternal history, the presence of abnormal hematologic studies or abnormal liver enzymes without explanation should prompt the nurse practitioner to investigate. Identifying NL in a baby may lead to the diagnosis of an autoimmune disorder in the mother (Hoath & Narendran, 2011). Consultation with cardiologists, dermatologists, hematologists, and gastroenterologists may be necessary to further investigate the diagnosis of NL. At-home care would include counseling to avoid direct sunlight (Inzinger et al., 2012). Counseling in regard to sun protection is advised because most of the cutaneous lesions are photosensitive. The location and visibility of the rash can be a source of discomfort to the parent. Reassurance that the rash will dissipate over time should provide some comfort to the family. If cutaneous findings are negative at birth but NL is suspected on the basis of maternal history, it may be prudent to obtain an electrocardiogram/echocardiogram to rule out heart block or cardiomyopathy (Pain & Beresford, 2007). Mothers may be concerned about passing lupus to the baby through breast milk. Pain & Beresford (2007) advised that maternal lupus is not a contraindication for breastfeeding. According to Lawrence (2011), SLE flares can be controlled with acetaminophen, ibuprofen, HCQ, ketorolac, or piroxicam. These medications are considered safe, and there are no contraindications to breastfeeding even if a mother is taking up to 120 mg/day of prednisone. The success of breastfeeding is based on the disease state, desire of the mother, and medications required to maintain a pain-free state. It is interesting to note that prolactin levels are elevated in pregnant women with SLE, and hyperprolactinemia is present in persons with Sjögren syndrome. In the hyperprolactinemia state, the abnormalities of secreting glands may lead to more difficulty in nursing Lawrence (2011).

processing....