What is Neonatal Lupus?
Neonatal lupus is an autoimmune disorder that involves the passing of the autoantibodies from the birthing parent to the baby during pregnancy. Neonatal lupus is a rare condition and is known to affect 1 in every 20,000 infants.(1) In Neonatal lupus, certain antibodies attack the cells in the body leading to symptoms and complications such as skin rash and heart issues.
How is Neonatal Lupus Acquired?
If a pregnant female has lupus, it doesn’t mean the baby will acquire it too. Lupus and neonatal lupus are not the same. The name is coined as the rashes, occurring in this condition are similar to lupus.(2) Therefore, having lupus does make it cause neonatal lupus in the child.(3) It is acquired by the antibodies in the mother’s body being passed to the fetus.
The antibodies such as anti-Ro/SSA, anti-La/SSB, or both, when pass from the placenta to the fetus, neonatal lupus occurs. These antibodies then attack the normal cells and organs in the body and lead to inflammation, kidney disease and heart diseases.
According to the experts, only one percent of the females pass anti-nuclear bodies, if present, to the babies.(4)
Symptoms of Neonatal Lupus
The signs of neonatal lupus may be observed before birth, especially if the baby is being monitored by the doctor for some condition.
Heart block in an infant is a condition that begins in an infant at the second or third trimester of pregnancy. In this condition, there is a disruption in the heart’s typical activity. The heart may skip a beat, have palpitations, beat slowly, or beat atypically.
Heart block is known to affect 5 percent of babies and occurs in 3 different levels, first, second and third. Third-degree is also known as the complete block.
A complete block may lead to the following symptoms:
Babies born with neonatal lupus may show skin lesions that may take a few weeks to appear.(4) These rashes appear on the face, scalp, upper back, and chest. The rashes usually fade away within a few weeks and may also completely disappear within a year without any noticeable scarring.
The babies may show liver complications and would have anemia, low white blood cell count, low platelets, and other blood abnormalities.
How is Neonatal Lupus Diagnosed?
If a mother has any condition that may put the infant at any risk the doctor keeps a watch on the mother and the baby closely for complications.
Regular echocardiograms may be ordered to keep a watch on baby heart activity to detect heart blocks.(5)
It can also be diagnosed after observing rashes and lesion on the baby’s skin at birth. A few tests may be ordered for Ro/La antibodies.
How is Neonatal Lupus Treated?
The treatment of neonatal lupus depends on how the condition is affecting the health of the baby. An infant who has skin lesion are monitored. Mostly the lesion disappears within 6 months without any treatment and does not cause any long-term scarring.
Clearing of the lesion indicates the clearing of the antibodies from the baby’s body.(6) During this period it is suggested by the experts to protect the skin of the baby from sunlight. Similarly, other complications affecting the liver and blood may go away without treatment in 4- 6 months.
Few babies may develop complications such as cholestasis hepatitis, liver failure and severe thrombocytopenia. In such cases, additional treatment may be required that mainly target the specific condition.
Babies with heart block should be monitored closely for progression of the condition if any. Some of the babies may need pacemakers to restore heart rhythm.
Babies who have only skin symptoms associated with neonatal lupus have a good outlook as the lesion is mostly cleared in a few months. It is also said even if the baby does not show any additional signs there are chances of developing lupus or any other autoimmune condition later in life. This has more to do with the overall genetic disposition. Babies with heart conditions have a mortality rate of 20-30%. Some babies with this condition may experience symptoms later in life when there is an increase in physical activity.
Is it Possible to Prevent Neonatal Lupus?
It is not possible to prevent neonatal lupus, but, this condition surely has a good outlook.
The poor outlook in this condition is usually related to heart blocks, which can be monitored for during the pregnancy. Certain medications can be ordered to prevent complications. Regular monitoring can help a doctor to assess the extent and give medication during pregnancy or place the pacemaker after birth, if required.