Clinical Analysis Of 21 Cases Of Neonatal Lupus Erythematosus And Their Mothers

Objective: The aim of the study is to understand the risk factors for neonatal lupus erythematosus(NLE),minimize misdiagnosis,prevent NLE and improve the prognosis of infant and their mothers by analyzing clinical data of 21 cases of NLE with their mothers.Methods: We recruited 21 cases of NLE from January 2015 to December 2019 in the Second Hospital of Hebei Medical University and Hebei Children’s Hospital.Clinical manifestations,investigations,diagnosis,treatments and prognosis of 21 patients with NLE and their mothers were analyzed retrospectively and prospectively.Results: 1.There were 21 cases of patients with NLE,including 11 male and 10 female.Rash is the most common clinical manifestation in patients with NLE,and NLE could involve cardiac,hepatobiliary and hematological systems as well.Antinuclear antibodies were positive in 20 cases,and a variety of extractable nuclear antigen antibodies such as anti-SSA,anti-SSB and anti-U1 RNP could be detected.One NLE patient did not detect autoantibodies;2.The longest follow-up period is 5 Years.Two of 21 patients lost visit and the other patients with NLE did not feel uncomfortable during the follow-up.The rash could gradually vanish in one year,while the elevating of transaminase and cardiac enzymes are most evanescent,which could back to normal level within one month after delivery.For autoantibodies,the latest period for changing negatively is 14 months after giving birth;3.The mean age of mothers was 27.9±3.99 years and their autoantibodies were basically consistent with their offspring.There were 13 mothers who had previously diagnosed connective tissue disease(CTD),including 9 cases of systemic lupus erythematosus,2 cases of primary sj?gren’s syndrome(PSS)and 2 cases of undifferentiated CTD;4.Two mothers lost visit and four mothers were diagnosed PSS after giving birth.A PSS mother was pregnant again,and one of the twins was unluckily developed NLE.Conclusions:1.Rash is the most common and initial clinical manifestation in patients with NLE,and NLE could involve cardiac,hepatobiliary and hematological systems as well,most of NLE patients have better prognosis.2.NLE is due to the transmission of maternal serum autoantibodies through the placenta,especially SSA,SSB and U1 RNP antibodies.With the decrease of maternal antibody concentration over time,the antibodies in NLE patients would disappear from half a year to one year after delivery with the improved clinical symptoms accordingly.3.Most of the mothers were diagnosed with CTD previously,and some mothers were asymptomatic but diagnosed with CTD via investigations after giving birth.The high risk for NLE exists with the mother if a previous child had NLE.4.NLE should be monitored during pregnancy or postpartum when cardiac abnormalities were detected in the fetus or newborn,especially when typical rashes occur in the newborn.autoantibody testing should be performed simultaneously with the infant,regardless of the mother’s health status,if necessary,follow up with a genetic test for the baby,other than genetic disorder.