Overview of Neonatal Lupus

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

Disclosures

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

In This Article

Associated Maternal Diagnosis

It is the placental transfer of specific antibodies from the mother to the fetus that initiates the clinical findings of NL. Maternal autoimmune diagnoses should prompt providers to closely observe the fetus/neonate for the development of NL. Not all mothers who are diagnosed with an autoimmune connective tissue disorder will produce offspring with NL. Yang et al. (2010) noted in a 10-year retrospective study that the presence of autoantibodies in a baby mirrored that of the mother although the quantity of antibodies was not necessarily the same. In the majority of cases, the amounts of antibodies were equal to or less than the mother's quantity of autoantibodies.

SLE is the predominate disease in which there is acquisition of autoantibodies by the fetus, and thus a review of this disease is in order. SLE is defined as a multisystem autoimmune disorder that affects connective tissue (Smyth & Garovic, 2009). No single test exists for SLE (Sawalha et al., 2006). The presence of anti-dsDNA antibodies is specific for SLE (Salmhofer, Hermann, Joch, Kerl, & Graninger, 2007), and a high anti-dsDNA titer is indicative of active SLE (Alanazi et al., 2009). SLE is a disease that predominates in women of childbearing age (Nodine et al., 2011) and African Americans (Sawalha et al., 2006). Borchers, Naguwa, Keen, and Gershwin (2010) noted that the incidence of SLE in women to men is 10:1, which suggests that sex hormones may be the influence in the development of this disease. Women with SLE often have comorbidity conditions such as infertility and nephritis. Smyth and Garovic (2009) noted a higher rate of infertility and spontaneous abortion in women who had active lupus nephritis who were treated with long-term cyclophosphamide.

SLE can be associated with other autoimmune disorders such as Sjögren syndrome and APS. Sjögren syndrome presents with inflammation in the glands, especially the lacrimal and parotid glands. The resulting dry mouth and eyes stem from hypofunction of the salivary and lacrimal glands (Shiboski et al., 2012). According to The American College of Rheumatology, a diagnosis of Sjögren syndrome requires two of the following: the presence of anti–SS-A and/or anti–SS-B or positive rheumatoid factor and ANA titer ≥1:320, with ocular staining, or lymphocytic sialadenitis scoring from a biopsy of the salivary gland (Shiboski et al., 2012).

Phospholipids facilitate the coagulation cascade (Blickstein & Friedman, 2011). The autoantibodies against phospholipids are termed "antiphospholipid antibodies." APS is defined as the presence of antiphospholipid antibodies in conjunction with venous thrombosis, arterial thrombosis, recurrent miscarriages, livedos reticularis, cutaneous ulcers, cardiac valvular disease, and/or thrombocytopenia (Smyth & Garovic, 2009). APS should be considered in a mother who has a maternal history of multiple fetal loses, intrauterine growth retardation, preterm labor, or venous or arterial thrombosis. Maternal laboratory findings would include lupus anticoagulant and medium or high titer anticardiolipin. APS is considered secondary if it is found in conjunction with SLE (Borchers et al., 2010).

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