Neonatal Lupus

...less medical jargon in a 'Quick Glance' format!

Neonatal Lupus: When lupus complicates pregnancy, one of the things that frightens prospective and new parents is the thought that their child might have their mother's disease. Parents who have heard of a condition called "neonatal lupus" often imagine that terrifying things might happen to their child. Most of the time they need not worry. The facts, as we understand them, are as follows:

It is very different from systemic lupus erythematosus; it does not develop into SLE.

It is rare.

In most cases, this disease disappears spontaneously in a few weeks, leaving no after-effects.

With a blood test, it is possible to tell which women will not deliver a child who develops neonatal lupus.

Many children with this disease are born to mothers who do not have SLE.

This disease is not the same as adult lupus. Babies with neonatal lupus do not develop arthritis, fever, kidney or brain disease.

This is a rare autoimmune disorder that is present at birth. Affected infants often develop a characteristic red rash or skin eruption. In addition, infants with neonatal lupus may develop liver disease, a heart condition known as congenital heart block, and/or low numbers of circulating blood platelets that assist in blood clotting functions. The symptoms associated with this, with the exception of congenital heart block, usually resolve within the first several months of life.

Symptoms:

Achy joints with swelling

Extreme fatigue

Unexplained rashes

Unexplained rashes that turn to sores, then scar

Butterfly rash across nose and cheeks

Anemia

Pain in the chest when deep breathing

Ulcers inside the mouth and nose

Photosensitivity

Heart/lung disorders

The symptoms of lupus differ from one person to another. Some people have just a few symptoms, while others have many. In addition, there are many different symptoms of lupus because the disease can affect any part of the body.

Cause:
The exact cause is unknown, although researchers speculate that specific antibodies that travel from a pregnant woman to her developing fetus via the placenta play a significant role.

Treatment:
The treatment for the cutaneous lesions is strict sun avoidance and mid to low-potency topical steroids. Systemic steroids are not required for managing cutaneous lesions. Systemic antimalarial treatment is not advisable due to its potential toxicity and slow onset of action. The parents should be counseled that the lesions are transient and will likely resolve by 6 to 8 months, usually without any evidence they were present. Residual, persistent telangiectasias can be treated with the pulsed-dye laser.

In CHB, there is some evidence that dexamethasone is helpful in preventing hydrops fetalis, and may have some effect in less-severe cases of AV block. Third-degree block never regresses but there are cases of second-degree block improving. Jonzon found several occurrences of sudden death in a group of patients with congenital heart block who were symptom free. In half, there were no preceding symptoms. He recommended early implantation of a pacemaker as the treatment of choice for all patients with CHB. However, there is no firm consensus regarding the management of CHB, either prenatally or after birth.

The infant should be referred to the appropriate pediatric specialist for evaluation and treatment of extracutaneous manifestations.

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...less medical jargon in a 'Quick Glance' format!