American Journal of Pediatrics

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Neonatal Lupus Erythematosus: Fifteen Cases Report and Review of Literature

Received: Dec. 03, 2023    Accepted: Jan. 15, 2024    Published: Feb. 01, 2024
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Abstract

Neonatal lupus erythematosus (NLE) is a rare autoimmune disease caused by the transplacental transfer of maternal autoantibodies, especially anti-Ro/SSA, anti-La/SSB, and anti-U1RNP. The objective of this study was to review the clinical, paraclinical, and therapeutic management of fifteen newborns admitted to a neonatal reanimation center at Children's Hospital A. Harouchi, Ibn Rochd University Hospital Centre. Results: Among these fifteen newborns, two categories were observed: the first category included eleven newborns of known lupus mothers in whom the electrocardiogram systematically requested came back normal. Skin lesions or biological abnormalities were found in some of these newborns, while others were completely asymptomatic. Simple clinical and paraclinical monitoring was performed, and the short- and long-term evolution was favorable. The second category included four newborns of mothers initially not known to have lupus but in whom the diagnosis of SLE was established after a maternal check-up because of neonatal bradycardia or suggestive skin lesions. In these four newborns, the systematic ECG revealed complete atrioventricular block in two and right bundle branch block in another. The cardiac ultrasound revealed cardiac malformations in three newborns. The systematic biological assessment showed abnormalities in two, and skin lesions were found in two newborns. In the cases of BAVc and BBD, the treatment consisted of pacemaker implantation, whereas simple monitoring was carried out in the newborn with cutaneous lesions. In conclusion, the clinical manifestations of NLE are varied; they may include temporary onset or irreversible symptoms such as congenital heart block (CHB), particularly third-degree heart block, which is the most serious complication of NLE because of its high morbidity and mortality rate and requires strict monitoring of all mothers with known lupus or with risk factors.

DOI 10.11648/ajp.20241001.12
Published in American Journal of Pediatrics ( Volume 10, Issue 1, April 2024 )
Page(s) 8-12
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Neonatal, Lupus Erythematosus, Autoantibody, Heart Block

References
[1] Wisuthsarewong W, Soongswang J, Chantorn R. Neonatal lupus erythematosus: clinical character, investigation and outcome. Pediatr Dermatol 2011; 28: 115-121.
[2] Diociaiuti A, Paone C, Giraldi L, Paradisi M, El Hachem M. Congenital Lupus erythematosus: case report and review of the literature. Pediatr Dermatol. 2005; 22(3): 240–2.
[3] Aguilera Peiró P, Vicente Villa A, Antonia González-Ensenat ˜ M. Lupus eritematoso neonatal. Semin Fund Esp Reumatol. 2011; 12: 15–20. 2.
[4] Gryka-Marton M, Szukiewicz D, Teliga-Czajkowska, Olesinska M: An Overview of Neonatal Lupus with Anti-Ro Characteristics. international journal of molecular sciences 2021, 22, 9281.
[5] León Muinos ˜ E, Monteagudo Sánchez B, Luaces González JE, García Santiago J. Lupus eritematoso neonatal. J An Pediatr. 2008; 69: 185–6. 3.
[6] Aparicio G, García-Patos V, Castells A. Lupus eritematoso neonatal. Piel. 2002; 17: 353–9.
[7] Brito-Zerón P, Izmirly P, Ramos-Casals M, Buyon J, Khamashta M. A. The clinical spectrum of autoimmune congenital heart block. Nat. Rev. Rheumatol. 2015, 11, 301–312.
[8] Lee LA. Neonatal Lupus erythematosus: clinical findings and pathogenesis. J Investig Dermatol Symp Proc 2004; 9: 52-56.
[9] tunaoglu F, Yildirim A, & Vurali D. (2010). Isolated congenital heart block. Texas Heart Institute Journal, 37(5), 579-583.
[10] Brucato A, Frassi M, Franceschini F, Cimaz R, Faden D, Pisoni M. P, Vignati G, Stramba-Badiale, M, Catelli L, Lojacono A, et al. Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: A prospective study of 100 women. Arthritis Rheum. 2001, 44, 1832–1835.
[11] Boros C. A, Spence, D, Blaser S, Silverman E. D. Hydrocephalus and macrocephaly: New manifestations of neonatal lupus erythematosus. Arthritis Rheum. 2007, 57, 261–266.
[12] Buyon J, Hiebert R, Copel J, Craft J, Friedman D, Katholi M, Lee L. A, Provost T. T, Reichlin M, Rider L, et al. Autoimmune-Associated Congenital Heart Block: Demographics, Mortality, Morbidity and Recurrence Rates Obtained from a National Neonatal Lupus Registry. J. Am. Coll. Cardiol. 1998, 31, 1658–1666.
[13] Julkunen H, Eronen M. The rate of recurrence of isolated congenital heart block: A population-based study. Arthritis Rheum. 2001, 44, 487–488.
[14] Sonesson S, Ambrosi A, Wahren-Herlenius M. Benefits of fetal echocardiographic surveillance in pregnancies at risk of congenital heart block: Single-center study of 212 anti-Ro52-positive pregnancies. Ultrasound Obstet. Gynecol. 2019, 54, 87–95.
[15] Shinohara K, Miyagawa S, Fujita T, Aono T, Kldoguchi KI. Neonatal lupus erythematosus: results of maternal corticosteroid therapy. Obstetrics and Gynecology. 1999; 93(6): 952–957.
[16] Inzinger M, Salmhofer W, Binder B. Neonatal Lupus erythematosus and its clinical variability. J Dtsch Dermatol Ges 2012; 10: 407-410.
[17] Pain, C., & Beresford, M. (2007). Neonatal lupus syndrome. Paediatrics and Child Health, 17(6), 223-227.
[18] Shahian, M., Khosravi, A., & Anbardar, M. (2011). Early cholestasis in neonatal lupus erythematosus. Annals of Saudi Medicine, 31(1), 80-82.
[19] Lee, L. (2009). The clinical spectrum of neonatal lupus. Archives of Dermatological Research, 301(1), 107-110.
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  • APA Style

    Lehlimi, M., Hayat, I. A. E., Derrak, L., Badre, A., Chemsi, M., et al. (2024). Neonatal Lupus Erythematosus: Fifteen Cases Report and Review of Literature. American Journal of Pediatrics, 10(1), 8-12. https://doi.org/10.11648/ajp.20241001.12

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    ACS Style

    Lehlimi, M.; Hayat, I. A. E.; Derrak, L.; Badre, A.; Chemsi, M., et al. Neonatal Lupus Erythematosus: Fifteen Cases Report and Review of Literature. Am. J. Pediatr. 2024, 10(1), 8-12. doi: 10.11648/ajp.20241001.12

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    AMA Style

    Lehlimi M, Hayat IAE, Derrak L, Badre A, Chemsi M, et al. Neonatal Lupus Erythematosus: Fifteen Cases Report and Review of Literature. Am J Pediatr. 2024;10(1):8-12. doi: 10.11648/ajp.20241001.12

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  • @article{10.11648/ajp.20241001.12,
      author = {Mouna Lehlimi and Imane Ain El Hayat and Lamyae Derrak and Amal Badre and Mounir Chemsi and Abdelhak Habzi and Said Benomar},
      title = {Neonatal Lupus Erythematosus: Fifteen Cases Report and Review of Literature},
      journal = {American Journal of Pediatrics},
      volume = {10},
      number = {1},
      pages = {8-12},
      doi = {10.11648/ajp.20241001.12},
      url = {https://doi.org/10.11648/ajp.20241001.12},
      eprint = {https://download.sciencepg.com/pdf/10.11648.ajp.20241001.12},
      abstract = {Neonatal lupus erythematosus (NLE) is a rare autoimmune disease caused by the transplacental transfer of maternal autoantibodies, especially anti-Ro/SSA, anti-La/SSB, and anti-U1RNP. The objective of this study was to review the clinical, paraclinical, and therapeutic management of fifteen newborns admitted to a neonatal reanimation center at Children's Hospital A. Harouchi, Ibn Rochd University Hospital Centre. Results: Among these fifteen newborns, two categories were observed: the first category included eleven newborns of known lupus mothers in whom the electrocardiogram systematically requested came back normal. Skin lesions or biological abnormalities were found in some of these newborns, while others were completely asymptomatic. Simple clinical and paraclinical monitoring was performed, and the short- and long-term evolution was favorable. The second category included four newborns of mothers initially not known to have lupus but in whom the diagnosis of SLE was established after a maternal check-up because of neonatal bradycardia or suggestive skin lesions. In these four newborns, the systematic ECG revealed complete atrioventricular block in two and right bundle branch block in another. The cardiac ultrasound revealed cardiac malformations in three newborns. The systematic biological assessment showed abnormalities in two, and skin lesions were found in two newborns. In the cases of BAVc and BBD, the treatment consisted of pacemaker implantation, whereas simple monitoring was carried out in the newborn with cutaneous lesions. In conclusion, the clinical manifestations of NLE are varied; they may include temporary onset or irreversible symptoms such as congenital heart block (CHB), particularly third-degree heart block, which is the most serious complication of NLE because of its high morbidity and mortality rate and requires strict monitoring of all mothers with known lupus or with risk factors.
    },
     year = {2024}
    }
    

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  • TY  - JOUR
    T1  - Neonatal Lupus Erythematosus: Fifteen Cases Report and Review of Literature
    AU  - Mouna Lehlimi
    AU  - Imane Ain El Hayat
    AU  - Lamyae Derrak
    AU  - Amal Badre
    AU  - Mounir Chemsi
    AU  - Abdelhak Habzi
    AU  - Said Benomar
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    PY  - 2024
    N1  - https://doi.org/10.11648/ajp.20241001.12
    DO  - 10.11648/ajp.20241001.12
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
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    EP  - 12
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/ajp.20241001.12
    AB  - Neonatal lupus erythematosus (NLE) is a rare autoimmune disease caused by the transplacental transfer of maternal autoantibodies, especially anti-Ro/SSA, anti-La/SSB, and anti-U1RNP. The objective of this study was to review the clinical, paraclinical, and therapeutic management of fifteen newborns admitted to a neonatal reanimation center at Children's Hospital A. Harouchi, Ibn Rochd University Hospital Centre. Results: Among these fifteen newborns, two categories were observed: the first category included eleven newborns of known lupus mothers in whom the electrocardiogram systematically requested came back normal. Skin lesions or biological abnormalities were found in some of these newborns, while others were completely asymptomatic. Simple clinical and paraclinical monitoring was performed, and the short- and long-term evolution was favorable. The second category included four newborns of mothers initially not known to have lupus but in whom the diagnosis of SLE was established after a maternal check-up because of neonatal bradycardia or suggestive skin lesions. In these four newborns, the systematic ECG revealed complete atrioventricular block in two and right bundle branch block in another. The cardiac ultrasound revealed cardiac malformations in three newborns. The systematic biological assessment showed abnormalities in two, and skin lesions were found in two newborns. In the cases of BAVc and BBD, the treatment consisted of pacemaker implantation, whereas simple monitoring was carried out in the newborn with cutaneous lesions. In conclusion, the clinical manifestations of NLE are varied; they may include temporary onset or irreversible symptoms such as congenital heart block (CHB), particularly third-degree heart block, which is the most serious complication of NLE because of its high morbidity and mortality rate and requires strict monitoring of all mothers with known lupus or with risk factors.
    
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Author Information
  • Department of Neonatal Reanimation (P4), Children's Hospital A. Harouchi, Faculty of Medicine and Pharmacy of Casablanca, Ibn Rochd University Hospital Centre, Hassan II University, Casablanca, Morocco

  • Department of Neonatal Reanimation (P4), Children's Hospital A. Harouchi, Faculty of Medicine and Pharmacy of Casablanca, Ibn Rochd University Hospital Centre, Hassan II University, Casablanca, Morocco

  • Department of Neonatal Reanimation (P4), Children's Hospital A. Harouchi, Faculty of Medicine and Pharmacy of Casablanca, Ibn Rochd University Hospital Centre, Hassan II University, Casablanca, Morocco

  • Department of Neonatal Reanimation (P4), Children's Hospital A. Harouchi, Faculty of Medicine and Pharmacy of Casablanca, Ibn Rochd University Hospital Centre, Hassan II University, Casablanca, Morocco

  • Department of Neonatal Reanimation (P4), Children's Hospital A. Harouchi, Faculty of Medicine and Pharmacy of Casablanca, Ibn Rochd University Hospital Centre, Hassan II University, Casablanca, Morocco

  • Department of Neonatal Reanimation (P4), Children's Hospital A. Harouchi, Faculty of Medicine and Pharmacy of Casablanca, Ibn Rochd University Hospital Centre, Hassan II University, Casablanca, Morocco

  • Department of Neonatal Reanimation (P4), Children's Hospital A. Harouchi, Faculty of Medicine and Pharmacy of Casablanca, Ibn Rochd University Hospital Centre, Hassan II University, Casablanca, Morocco

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