eMedicine Specialties > Pediatrics: General Medicine > Rheumatology

Neonatal Lupus and Cutaneous Lupus Erythematosus in Children: Follow-up

Author: Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Contributor Information and Disclosures

Updated: Jul 20, 2009

Follow-up

Further Inpatient Care

  • Inpatient care is not needed for patients with skin disease.

Further Outpatient Care

  • Patients with neonatal lupus erythematosus (NLE) of the skin do not require monitoring after lesions resolve. They may be more prone to develop lupus erythematosus later in life, but this reflects their genetic predisposition, not that they had neonatal lupus erythematosus. Their nonaffected siblings are also at risk for development of systemic lupus erythematosus.
  • Patients with neonatal lupus erythematosus with cardiac involvement require regular monitoring to assess cardiac function and the need for a pacemaker.

Transfer

  • Consider transfer to a tertiary care center for all children and neonates with lupus erythematosus.

Deterrence/Prevention

  • Mothers of neonates with neonatal lupus erythematosus, particularly neonates with CHB, have a 2-fold to 3-fold increased risk of subsequent affected neonates. An estimated 25% of subsequent pregnancies are affected. Therefore, carefully monitor subsequent pregnancies, particularly at 18-24 weeks’ gestation.
  • Consult an obstetrician with experience with high-risk pregnancies and consider administration of prednisolone or fluorinated steroids during subsequent pregnancies to prevent neonatal lupus erythematosus. In at least one instance, CHB was prevented with the use of corticosteroids beginning at 10 weeks’ gestation, azathioprine shortly thereafter, and plasmapheresis beginning at 18 weeks’ gestation.2

Prognosis

  • Neonatal lupus erythematosus
    • Generally, skin disease is self-limited.
    • Hepatosplenomegaly is self-limited, although death due to hepatitis may occur.
    • Cytopenia is self-limited; however, if severe thrombocytopenia is present, bleeding can affect the prognosis.
    • Cardiac involvement is associated with a poor outcome in many patients, including some who receive pacemakers.

Patient Education

  • Assess and educate the mother about follow-up care for a child with neonatal lupus erythematosus and the potential effects on subsequent pregnancies.
  • Instruct patients about sun avoidance, use of protective clothing, and proper use of sunscreens and topical corticosteroids.
  • For excellent patient education resources, visit eMedicine's Blood and Lymphatic System Center. Also, see eMedicine's patient education article Lupus (Systemic Lupus Erythematosus).
  • In mothers who are asymptomatic at the time of delivery of a neonate with cutaneous neonatal lupus erythematosus or CHB, assess for the future development of lupus erythematosus or another collagen vascular disease.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose
  • Failure to recognize cardiac complications of neonatal lupus erythematosus (NLE)
  • Failure to monitor subsequent pregnancies or the course of the mother

Special Concerns

  • Prenatal ultrasonography may help identify neonatal lupus erythematosus that affects the heart.
 


More on Neonatal Lupus and Cutaneous Lupus Erythematosus in Children

Overview: Neonatal Lupus and Cutaneous Lupus Erythematosus in Children
Differential Diagnoses & Workup: Neonatal Lupus and Cutaneous Lupus Erythematosus in Children
Treatment & Medication: Neonatal Lupus and Cutaneous Lupus Erythematosus in Children
Follow-up: Neonatal Lupus and Cutaneous Lupus Erythematosus in Children
Multimedia: Neonatal Lupus and Cutaneous Lupus Erythematosus in Children
References
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References

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Further Reading

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Keywords

neonatal lupus, cutaneous lupus erythematosus, lupus erythematosus of childhood, neonatal lupus erythematosus, LE, NLE, cutaneous lesions, SCLE, subacute cutaneous lupus erythematosus, discoid lupus erythematosus, DLE, congenital heart block, CHB, telangiectasia, dyspigmentation, atrophic lesions, syncope, heart failure, Sjögren syndrome, arthritis, arthralgia, hepatosplenomegaly, pneumonitis, drug-induced lupus erythematosus, prolonged QT interval

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Contributor Information and Disclosures

Author

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Genetech Honoraria Consulting; Celgene Honoraria Consulting

Medical Editor

Barry L Myones, MD, Associate Professor, Departments of Pediatrics and Immunology, Pediatric Rheumatology Section, Baylor College of Medicine; Director of Research, Pediatric Rheumatology Center, Texas Children's Hospital
Barry L Myones, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American College of Rheumatology, American Heart Association, American Society for Microbiology, Clinical Immunology Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Thomas JA Lehman, MD, FAAP, FACR, Clinical Professor of Pediatrics, Department of Pediatrics, Division of Pediatric Rheumatology, Weill-Cornell University; Chief, Hospital for Special Surgery
Thomas JA Lehman, MD, FAAP, FACR is a member of the following medical societies: PM American Allergy Society
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Lawrence K Jung, MD, Chief, Division of Pediatric Rheumatology, Children's National Medical Center
Lawrence K Jung, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Rheumatology, Clinical Immunology Society, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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