What You Should Know About Neonatal Lupus

Neonatal lupus is an uncommon hereditary autoimmune condition which affects someone upon birth. Babies with neonatal lupus have red rashes or skin breakouts. The affected person is most likely to have congenital heart block. Since congenital heart block isn’t treatable in the initial months after birth, the affected infant may need a pacemaker. The infant may have skin complication symptoms, heart complication symptoms, or both (less likely). Although it isn’t common, the victim may suffer from liver illness, an unusually large head, low blood platelet, and white and red blood cell counts. Neonatal lupus is caused by particular antibodies that move from an expectant mother to her unborn baby. Though it is unclear how it happens, the auto-antibodies destroy particular tissues of the fetus. Neonatal lupus is different from lupus. The former was named this because the skin rash looks like the one caused by lupus. Neither the neonatal lupus affected child nor the mother has lupus.

Neonatal Lupus Symptoms

Antibodies: Neonatal lupus is believed to be caused by the movement of antibodies into the placenta. The antibodies are risky to the developing unborn baby since the placenta can’t differentiate between the important antibodies from the harmful ones. These antibodies damage the healthy tissues of the fetus affecting the blood, skin and liver. Antibodies from a woman who has anti-Ro or anti-La antibodies will move to the fetus. Nevertheless, only 2% of unborn babies will have neonatal lupus. Although the studies have not explained why this happens, it is believed that other factors related to genes and the environment are responsible. APL antibodies cause phospholipid antibody syndrome as well. Although the condition is neither related to neonatal lupus or its symptoms, it possibly increases chances of miscarriage and preeclampsia in a pregnant woman, as well as slow fetal development. Tests for anti-Ro, anti-La and PL antibodies are recommended for women with autoimmune conditions such as lupus rheumatoid arthritis and Sjogren's, among others. 

Congenital Heart Block: Congenital heart block is likely to be the most severe issue related to neonatal lupus. Due to the damage of the electrical signals which normally activates the heartbeat, the condition can be fatal. The damage leads to abnormally slow heartbeat which may cause sudden unconsciousness, reduced breath, and uneven heartbeat. In serious cases, the slow heartbeat can cause cardiac arrest and severe malfunction of the heart.  In cases where there are n structural heart problems, neonatal lupus causes approximately 85% of congenital heart block incidences.  Using an echocardiogram, congenital heart block can be diagnosed from 18 weeks of the unborn baby’s growth. 

 Skin Rash: Neonatal lupus skin rashes normally develop in the first few months after the baby is born. The rash normally affects the face, areas around the eyes, the scalp, and exposure to sun can worsen them. The rash, which looks like an SLE rash, has red wounds. The skin rash is more likely to affect infant females than males. Although the rash is temporary, in very few incidences, the skin wounds may continue to exist throughout childhood.

Causes of neonatal lupus

Although it is not common, neonatal lupus develops when particular antibodies move from an expectant woman to the growing unborn baby, through the placenta. Rarely, neonatal lupus skin rash is related to the reaction of another antibody against another ribonucleoprotein type. However, the babies suffering from the latter condition don’t experience other symptoms like congenital heart block.

The body’s immune system produces antibodies to fight antigens (alien substances). Antigens include substances such as disease-causing microorganisms, toxins, among others. During the expectancy period, antibodies move from the mother, through the placenta, to the unborn baby. This usual process is vital since the fetus itself isn’t able to produce antibodies. For neonatal lupus cases, auto-antibodies, which destroys healthy tissues by mistake are also transferred to the fetus. The bodies of people with autoimmune conditions such as lupus and Sjogren’s syndrome, among others, produce auto-antibodies. The auto-antibodies damage the healthy tissue of the fetus, causing multiple neonatal lupus symptoms. It is not clear how these antibodies affect the unborn baby.

Mothers whose babies have neonatal lupus mustn’t themselves have lupus. These women are potentially suffering from other conditions like Sjogren’s syndrome or rheumatoid RA. Only approximately two out a hundred infants with neonatal lupus are born to mothers with lupus. Mostly, mothers with anti-Ro or anti-La antibodies may not experience rheumatic disease symptoms. In other cases, they may only have slight rheumatic symptoms or may be found to have an autoimmune condition only after the child is confirmed to have neonatal lupus. There are higher chances that a mother will have a child with heart block if she already has already had one of the conditions.

All expectant mothers with the anti-Ro or anti-La antibodies pass the antibodies to their unborn babies, but only two percent of the infants will have neonatal lupus. Due to this, researchers attribute other reasons such as genetic and environmental factors in the development of neonatal lupus. 

Identifying neonatal lupus

A neonatal lupus diagnosis is done through a comprehensive clinical assessment of the history of the patient and their family as well as various specialized examinations. An Anti-Ro or anti-La antibody exam in an infant assists in the confirmation of neonatal lupus diagnosis. During or before birth, congenital heart block, a condition which is at times related to neonatal lupus, may be identified. Echocardiography is carried out to assist in the heart block diagnosis and evaluation of the heart’s activity.

Vulnerable individuals

Although Neonatal lupus is not as gender-discriminating as systemic lupus, it slightly affects more females than males. Apart from being a rare condition, most of its symptoms (apart from congenial heart block) are not permanent and they normally heal themselves in few months time. Although it isn’t clear how it exactly occurs, neonatal lupus affects approximately one out of 15,000 infants. Approximately more than 85% of congenital heart block cases are caused by neonatal lupus.

Associated conditions

The following conditions have symptoms which can be same as those found in neonatal lupus, but they have other additional signs which are different. In order to differentiate the diagnosis, the comparison may be vital.

Various conditions are manifested by skin rash symptoms during birth. These disorders include; Bloom-Torre-Machacek syndrome, several syndromes characterized by a skin rash that are present at birth (congenital) including Bloom syndrome, RTS, LCH, granuloma annulare, childhood dermatomyositis, ringworm, erythema multiforme, eczema, seborrheic eczema and psoriasis. There are other conditions that can develop a few weeks before or after birth. These include several infections that can occur in the weeks just before or after birth (prenatal) including congenital rubella, CMV, congenital syphilis, and group B Strep.

How neonatal lupus is treated

Neonatal lupus treatment focuses on individual‘s specific symptoms. Most of the condition’s symptoms heal spontaneously several months after birth. Young babies with neonatal lupus must be thoroughly tested to find out if they have any liver or blood problems.

Infants should be protected from sunlight, using sunscreen and clothes that protect them from exposure. Although mostly they don’t require any treatment, skin symptoms may be treated using mild topical steroids.

Body temperatures of infants diagnosed with neonatal lupus must be regularly monitored to check for congenital heart block. Nevertheless, neonatal lupus doesn’t need frequent heart assessment if there are no symptoms of cardiac issues before or at birth. Most young babies need a pacemaker implantation. The heart activity of babies with neonatal lupus should be monitored periodically if they don’t require a pacemaker later in childhood. Other treatments manage the symptoms and also prevent the condition from becoming worse.