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Neonatal Lupus

What is a Neonatal lupus?
Neonatal lupus is a form of lupus seen in a newborn born to a mother with lupus or sjogren's syndrome due to transfer of autoantibodies across the placenta.
What are the symptoms of neonatal lupus?
The most obvious symptom of neonatal lupus is the appearance of facial rash (butterfly rash similar to lupus). It can also lead to anemia (due to destruction of red blood cells by autoantibodies), decrease in platelet count (platelet destruction by autoantibodies). These features generally settle by 6-8 months. This is due to clearance of the maternal autoantibodies from the fetal circulation by this period.
What causes congenital heart block of neonatal lupus?
Congenital heart block in the newborn is due to the transfer of anti Ro/ anti La antibodies across the placenta. This leads to disturbance in the electrical circuit in the heart & leads to irregular heartbeats in the neonate. The heart block requires early pacemaker insertion. Unlike other features, heart block is a permanent feature & does not settle by 6- 8 months.
Can congenital heart block be diagnosed early?
Yes. This can be diagnosed with a fetal ECHO during pregnancy itself. Anti-Ro/ Anti-La test is always done during pregnancy to avoid this complication. If diagnosed early steroids that cross the placenta can be given. IV immunoglobulins have also been tried to prevent the occurrence of congenital heart block.
I have lupus; what are the chances of congenital heart block in my baby?
The chance of a baby with congenital heart block to a lupus mother is 1- 2 %. With a positive anti-Ro/ La antibody, there is a 5% chance of the baby having congenital heart block. The risk increase to 15% with subsequent pregnancies.
How does a child with neonatal lupus fare in the long run?
Skin rash associated with neonatal lupus generally settles in a few months. Congenital heart block can be fatal in about 20% infants. These infants can otherwise do well with a timely pacemaker insertion. An occasional child with neonatal lupus may develop SLE after 10- 15 years.
All children with neonatal lupus should be screened for lupus at 16- 20 years of age.

Ref: Oxford handbook of Rheumatology- Alan J Hakim, Gavin P. R. Clunie. Oxford publications.
Neonatal lupus syndromes. Peter M. Izmirly et al. Rheumatic Disease Clinics of North America 33 (2007) 267-285.

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Created on: April 2007
Last updated on: Feb 2015
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