Neonatal lupus erythematosus: results of maternal corticosteroid therapy

Shinohara, Koji; Miyagawa, Sachiko; Fujita, Tomio; Aono, Toshihiro; Kidoguchi, Kinichi

doi:10.1016/s0029-7844(99)00006-x

Cited by 93 publications

(69 citation statements)

References 31 publications

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“…Although 1 limited retrospective study from Japan suggested the efficacy of prednisone in preventing block, 14 this therapy (at least in low and moderate doses) early in pregnancy did not prevent block in several cases previously reported. 5 Prednisone would not be expected to be efficacious because maternal administration does not decrease levels of anti-SSA/Ro-SSB/La antibodies, 15 and placental 11␤-dehydrogenase prevents active drug from reaching the fetal circulation.…”

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confidence: 82%

Utility of Cardiac Monitoring in Fetuses at Risk for Congenital Heart Block

et al. 2008

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Background-Anti-SSA/Ro-associated third-degree congenital heart block is irreversible, prompting a search for early markers and effective therapy. Methods and Results-One hundred twenty-seven pregnant women with anti-SSA/Ro antibodies were enrolled; 95 completed an evaluable course in 98 pregnancies. The protocol included fetal echocardiograms performed weekly from 16 to 26 weeks' gestation and biweekly from 26 to 34 weeks. PR intervals Ͼ150 ms were considered prolonged, consistent with first-degree block. Ninety-two fetuses had normal PR intervals. Neonatal lupus developed in 10 cases; 4 were neonatal lupus rash only. Three fetuses had third-degree block; none had a preceding abnormal PR interval, although in 2 fetuses Ͼ1 week elapsed between echocardiographic evaluations. Tricuspid regurgitation preceded third-degree block in 1 fetus, and an atrial echodensity preceded block in a second. Two fetuses had PR intervals Ͼ150 ms. Both were detected at or before 22 weeks, and each reversed within 1 week with 4 mg dexamethasone. The ECG of 1 additional newborn revealed a prolonged PR interval persistent at 3 years despite normal intervals throughout gestation. No first-degree block developed after a normal ECG at birth. Heart block occurred in 3 of 16 pregnancies (19%) in mothers with a previous child with congenital heart block and in 3 of 74 pregnancies (4%) in mothers without a previous child with congenital heart block or rash (Pϭ0.067). Conclusions-Prolongation of the PR interval was uncommon and did not precede more advanced block. There was a trend toward more congenital heart block in fetuses of women with previously affected offspring than those without previously affected offspring. Advanced block and cardiomyopathy can occur within 1 week of a normal echocardiogram without initial first-degree block. Echodensities and moderate/severe tricuspid regurgitation merit attention as early signs of injury. (Circulation. 2008;117:485-493.)

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confidence: 82%

Utility of Cardiac Monitoring in Fetuses at Risk for Congenital Heart Block

et al. 2008

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“…However, fetal pacing has not been established and needs further improvement, because of its risk of premature delivery, secondary infection and difficulties in keeping the pacemaker lead in a suitable position [3]. Maternal steroid therapy in early pregnancy has been reported to be useful; however, it is suggested to be ineffective for fetuses who have already developed complete heart block [4]. Sympathomimetics have also been tried for the treatment of fetal heart block.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Fetal Congenital Complete Heart Block with Maternal Administration of Beta-Sympathomimetics (Terbutaline)

Yoshida

Iwamoto

Sakakibara³

et al. 2001

Gynecol Obstet Invest

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We report a case of fetal congenital heart block treated with maternal administration of beta-sympathomimetics. The case was diagnosed as fetal complete heart block associated with maternal anti-Ro/SS-A antibody at 22 weeks of gestation. By fetal sonography, the ventricular rate was revealed to be 60 beats/min and mild cardiomegaly was shown. We initiated maternal administration of a sympathomimetic, specifically terbutaline, to prevent fetal heart failure. An increase in the fetal ventricular rate and an improvement in cardiac function were both achieved during the treatment. A viable infant was delivered by an elective cesarean section without complications at term. Maternal administration of the beta-adrenergic agent terbutaline is suggested to be effective for improving fetal congenital heart block in order to prevent heart failure in utero.

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“…Accordingly, the interpretation of their benefi t in reducing the risk of cardiac-NL is limited [ 106 ]. Two other studies restricted to fl uorinated steroids showed that their prophylactic use did not associate with a reduction in recurrent cases of cardiac-NL [ 25 , 107 ].…”

Section: Prophylaxis and Treatmentmentioning

confidence: 99%