Overview of Neonatal Lupus

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

Disclosures

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

In This Article

What is Neonatal Lupus?

NL is the clinical manifestations presented in the newborn or fetus that is the product of a mother with anti–SS-A/Ro, anti–Sjögren syndrome–B (anti–SS-B/La), and/or anti–ribonuclear protein (anti-RNP) antibodies (Guinovart, Vincente, Rovira, Suñol, & González-Enseñat, 2012). These antibodies present in mothers who have been diagnosed with SLE, Sjögren syndrome, antiphospholipid syndrome (APS), or other autoimmune tissue disorders (Wisuthsarewong, Soongswang, & Chantorn, 2011). NL is similar to SLE in that one or more body system can be involved simultaneously (Blickstein & Friedman, 2011), with the dominate feature of cutaneous lesions in the majority of cases. This article will provide an overview of NL in addition to an overview of the maternal presentation, including clinical presentations of the most pronounced findings of cutaneous lesions and cardiac abnormalities. The infrequent manifestations in the hematologic, hepatic, musculoskeletal, and central nervous system will also be presented.

Prenatal administration of steroids have been the mainstay in attempts to prevent or reverse first- and second-degree congenital heart block (CHB) and to prevent progression to a more advanced stage. Additional methods under investigation include steroids in conjunction with intravenous immunoglobulin (IVIG) and plasmapheresis. Common fetal and uncommon neonatal findings, along with pathogenesis, will be reviewed. After the pathophysiology is reviewed, this article will provide guidelines for practitioners so they can consider NL as a differential diagnosis when presented with cutaneous lesions with or without CHB. NL also should be considered as a differential diagnosis in a newborn with abnormal presentations in hematologic, hepatobiliary, neurologic, or musculoskeletal systems that cannot otherwise be explained.

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