Neonatal lupus (NL) is a disease of the newborn which can be detected early in pregnancy and is linked to Anti-Ro & Anti-La antibodies. The most dreaded complication of this disease is the presence of 2nd or 3rd degree heart block, sometimes leading to Complete Heart Block (CHB). Other manifestations like skin rashes, transient elevations of transaminases and cytopenias (hematological) are of no serious consequence and can be treated symptomatically. The management of NL is primarily a preventive strategy and involves close cardiac monitoring of the fetus during the 18th-32nd week of pregnancy.

1. The management of neonatal lupus syndrome

2. Apollo Medicine 2012 September
Volume 9, Number 3; pp. 280e281 Algorithms
The management of neonatal lupus syndrome
Sundeep Upadhyaya
ABSTRACT
Neonatal lupus (NL) is a disease of the newborn which can be detected early in pregnancy and is linked to Anti-Ro &
Anti-La antibodies. The most dreaded complication of this disease is the presence of 2nd or 3rd degree heart block,
sometimes leading to Complete Heart Block (CHB). Other manifestations like skin rashes, transient elevations of
transaminases and cytopenias (hematological) are of no serious consequence and can be treated symptomatically.
The management of NL is primarily a preventive strategy and involves close cardiac monitoring of the fetus during the
18the32nd week of pregnancy.
REFERENCES
1. Brucato A, Cimaz R, Caporali R, Ramoni V, Buyon J.
Pregnancy outcomes in patients with autoimmune
diseases and the anti-Ro/SSA antibodies. Clin Rev
Allergy Immunol. 2011;40:27.
2. Buyon JP, Clancy RM, Friedman DM. Cardiac manifes-tations
of neonatal lupus erythematosus: guidelines to
management; integrating clues from bench to bedside.
Nat Clin Rhematol. 2009;5:139.
Senior Consultant, Rheumatology-Immunology, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India.
email: sundeepupadhyaya@hotmail.com
Available online: 25.7.2012
http://dx.doi.org/10.1016/j.apme.2012.07.019

3. The management of neonatal lupus syndrome Algorithms 281
(a)
a. For newborns or infants with dermatological/hepatic/hematological manifestations without Heart Block/ Cardiac manifestations, local corticosteroid
application, UV light protection and rarely systematic corticosteroids for short periods is adequate.
b. Titers of Anti- Ro & Anti La and their definitions of low and high titer differ from lab to lab. Some clinicians may also refer to the Anti RNP
antibodies and test them, but the link is currently not tenable.
c. Consent for Dexamathasone/Betamethasone, use must include the following risks explained to the mother
i. Infection ii. Hypertension iii. AVN & gestational diabetes iv. Growth restriction and oligo hydramnios

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