related: Pediatric
path: transferred maternal IgG autoantibodies
symptoms: Infants can have thrombocytopenia, neutropenia, rash, liver dysfunction (petechiae), and a congenital heart block.
Most manifestations are self resolved; however, the congenital heart block is permanent and frequently requires pacing.,
Neonatal lupus can develop from transplacental passage of maternal anti-SSA (Ro) and anti-SSB (La) antibodies. The presence of these antibodies in the mother is associated with a small (<2%) but significant risk of congenital complete heart block. Hepatic, hematologic, and dermatologic complications are also possible. Hydroxychloroquine does not have significant fetal toxicity, and discontinuation during pregnancy is associated with an increase in maternal SLE activity (Choice B). In contrast, cyclophosphamide, methotrexate, leflunomide, and mycophenolate are contraindicated in pregnancy.