The Importance of the Level of Maternal Anti-Ro/SSA Antibodies as a Prognostic Marker of the Development of Cardiac Neonatal Lupus Erythematosus

Jaeggi, Edgar; Laskin, Carl A.; Hamilton, Robert M.; Kingdom, John; Silverman, Earl D.

doi:10.1016/j.jacc.2010.02.042

Cited by 246 publications

(221 citation statements)

References 32 publications

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“…On the other hand, infants exposed to high titers of anti-SSB/La were more likely to have noncardiac manifestations of neonatal lupus [10].…”

Section: Epidemiologymentioning

confidence: 99%

“…The incidence of cardiac manifestations in neonatal lupus increases to about 17 % in women with anti-SSA/Ro and/or anti-SSB/La antibodies who have had a previous child with congenital heart block [8], a previous child with cutaneous neonatal lupus without cardiac manifestations [9], and in women with high titers of anti-SSA/Ro and anti-SSB/La compared to low titers [10]. On the other hand, infants exposed to high titers of anti-SSB/La were more likely to have noncardiac manifestations of neonatal lupus [10].…”

Section: Epidemiologymentioning

confidence: 99%

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Neonatal Lupus Erythematosus

Nasef

Hafez²,

Bakr³

2014

NCP

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Neonatal lupus is a passively acquired autoimmune disease that occurs in offspring of mothers with anti-SSA/Ro and/or anti-SSB/La antibodies. The primary clinical features are a photosensitive rash that is usually found on the scalp and periorbital areas, congenital heart block with or without cardiomyopathy, cytopenias, disseminated intravascular coagulation, and neonatal cholestasis with or without elevated transaminases. The diagnosis is usually made in utero by detection of a slow fetal heart rate and subsequent fetal echocardiographic confirmation of heart block and/or cardiomyopathy. Prenatal treatment with fluorinated glucocorticoids beginning as soon after detection has favourable outcome for mothers of fetuses with second degree heart block, is of no value for mothers of fetuses with third degree heart block, and controversial for mothers of fetuses with first degree heart block. Prenatal glucocorticoids can be used also in presence of cardiomyopathy associated with neonatal lupus. Hydroxychloroquine has been used in pregnant women who have anti-SSA/Ro antibodies and who have previously given birth to a child with cardiac manifestations. First and second degree block, detected in utero or at birth, can progress to complete heart block. Infants with complete heart block usually require a pacemaker with an excellent prognosis, although development of heart failure may occur.

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“…On the other hand, infants exposed to high titers of anti-SSB/La were more likely to have noncardiac manifestations of neonatal lupus [10].…”

Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Neonatal Lupus Erythematosus

Nasef

Hafez²,

Bakr³

2014

NCP

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“…Las otras 14 publicaciones seleccionadas corresponden a 9 revisiones de la literatura (2, 3, 6, 7, 18-22) y a 5 estudios de cohorte: 3 retrospectivas (8, 11, 13) y 2 prospectivas (9, 12). Sus enfoques fueron en pronóstico (11,13), y diagnóstico y pronóstico (8,9,12). Se realizaron en Estados Unidos (8), Italia (9), Finlandia (11), Canadá (12) y Estados Unidos (13).…”

Section: Resultsunclassified

“…Lo anterior contrasta con el bloqueo de origen inmunológico cuya mortalidad intrauterina es de 6 %, mortalidad global del 16-19 %, y cuando se asocia a fibroelastosis endocárdica es del 69 %, lo cual requiere el uso de marcapasos hasta en un 70 % de los casos durante los 10 primeros años de vida (11,12). El riesgo de recurrencia en gestaciones futuras es del 10-17,4 % (13).…”

Section: Introductionunclassified

Bloqueo auriculoventricular fetal completo: enfoque diagnóstico y terapéutico; reporte de caso en Bogotá, Colombia y revisión de la literatura

Poveda-Rojas¹,

Vélez-Tirado²,

Bonilla-Cortes³

et al. 2017

Rev. Colomb. Obstet. Ginecol.

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RepoRte de caso Rev Colomb Obstet Ginecol 2017;68:305-312 RESUMENObjetivo: reportar un caso de bloqueo auriculoventricular completo congénito y realizar una revisión de la literatura del diagnóstico y tratamiento. Materiales y métodos: se reporta el caso de una gestante de 27 años quien consulta a un hospital general de alto nivel de complejidad, con un embarazo de 33 semanas, con feto único, con diagnóstico de bloqueo auriculoventricular completo y cardiomiopatía dilatada secundaria. Se inició manejo prenatal con betamimético con pobre respuesta, por lo cual fue necesario finalizar el embarazo. El recién nacido requiere implantación de marcapasos ventricular en el primer día de vida con excelentes resultados en el seguimiento a un año. Se realiza revisión de la literatura publicada en las bases de datos: Medline vía PubMed, Lilacs y SciELO mediante los términos: "fetal complete atrioventricular block", "congenital 1 Ginecoobstetra, Universidad Militar Nueva Granada, Bogotá (Colombia).dianeporo718@hotmail.com 2 Pediatra, Universidad Militar Nueva Granada, Bogotá (Colombia). complete heart block", con límites de año de 2000 a 2016, en español e inglés. Resultados: se obtuvieron 21 publicaciones; siete reportes de caso, diez revisiones de literatura, cuatro estudios de cohorte. El diagnóstico se basa en la ecocardiografía fetal para determinar el intervalo PR, la relación auriculoven tricular y la detección de anomalías intracardiacas, entre las que se encuentran: regurgitación valvular, hiperecogenicidad miocárdi-ca/valvular-fibroelastosis endocárdica, contracciones atriales prematuras y efusión pericárdica. Respecto al tratamiento prenatal, los medicamentos más utilizados son los corticoesteroides y los betamiméticos. El tratamiento de la bradiarritimia severa refractaria neonatal puede requerir la implantación de un marcapaso como manejo definitivo. Conclusión: el bloqueo AV congénito de tercer grado requiere diagnóstico temprano y tratamiento oportuno, ya que se acompaña de alta morbimortalidad perinatal. Se requieren estudios con mayor calidad metodológica que permitan avalar otras opciones y esquemas terapéuticos prometedores. Palabras clave: bradiarritmia, bloqueo atrioventricular, lupus eritematoso sistémico.

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“…Leading investigators in this area suggest weekly to biweekly fetal echocardiography performed at varying intervals and time points with overall range between 16 and 28 weeks' gestation. [6][7][8][9] Maternal anti-SSA antibodies cross the placenta and initiate an immune mediated cascade of events that results in fibrosis of the cardiac atrioventricular node 10 or myocarditis. Late onset cardiomyopathy in the postnatal period has been described as well.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of fetal echocardiographic surveillance in anti‐SSA exposed fetuses at a large fetal cardiology center

et al. 2014

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The Importance of the Level of Maternal Anti-Ro/SSA Antibodies as a Prognostic Marker of the Development of Cardiac Neonatal Lupus Erythematosus

Abstract: Our findings support that the amount of maternal antibodies, rather than their presence, is associated with fetal tissue injury. As anti-Ro levels correlate with the risk of cardiac complications, serial echocardiography should be limited to women with high anti-Ro-titres.

Cited by 246 publications

References 32 publications

Neonatal Lupus Erythematosus

Neonatal Lupus Erythematosus

Bloqueo auriculoventricular fetal completo: enfoque diagnóstico y terapéutico; reporte de caso en Bogotá, Colombia y revisión de la literatura

Outcomes of fetal echocardiographic surveillance in anti‐SSA exposed fetuses at a large fetal cardiology center

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