Overview of Neonatal Lupus

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

Disclosures

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

In This Article

Discussion

SLE, Sjögren syndrome, and other connective tissue autoimmune disorders tend to be diagnosed in the years of fertility. NL is the expression of anti–SS-A/Ro, anti–SS-B/La, and anti-RNP in the fetus or newborn. The presence of antibodies can be in any combination. Of the babies identified as having NL, only 30% to 50% of the mothers have been identified with SLE or Sjögren syndrome. In the fetus, a low heart rate noted on a prenatal ultrasound can point to the potential lethal consequence of these antibodies. It is important to keep in mind that not all mothers who express autoantibodies will produce a baby with NL. Inconsistent data have been shown in the prenatal administration of dexamethasone as a single agent or in combination with IVIG and/or plasmapheresis. These agents, although inconsistent, have been shown to reverse first- or second-degree CHB; however, no therapeutic regimen is available at this time to reverse or decrease third-degree heart block. Heart block can develop in utero or postnatally, and therefore it is important to follow-up with babies who have a positive maternal history even if prenatal screening was negative. NL may be underdiagnosed because some mothers are asymptomatic and the presenting rash mimics other newborn rashes (Heughan & Kanigsberg, 2007). Brucato and colleagues (2009) compared CHB not associated with anti-Ro/La antibodies to cases with babies positive for anti-Ro/La antibodies. In a sample size of 45 fetuses with CHB, 20% were negative for anti-Ro/La antibodies. The CHB had no known etiology.

Cutaneous findings can be deceptive in that they can mimic benign or serious skin lesions. A biopsy would be useful if a rash is persistent and may be resistant to topical treatment, especially if the mother has no known history of autoimmune disease.

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