Bradycardia in a Neonate

  • Ross Petty
  • Farhad Salehzadeh


  • The most important complication of neonatal lupus erythematosus (NLE) is congenital heart block (CHB)

  • Infants with NLE are born to mothers who have antibodies against Ro (SSA) and/or La (SSB) antigens, although the mother may be completely asymptomatic

  • Most children with CHB will eventually require a permanent pacemaker during childhood

  • The risk of having a second baby with congenital heart block is within the range of 15–20%


Neonatal lupus erythematosus SSA Congenital heart block 


  1. 1.
    Vanoni F, Lava SAG, Fossali EF, Cavalli R, Simonetti GD, Bianchetti MG, Bozzini MA, Agostoni C, Milani GP. Neonatal systemic lupus erythematosus syndrome: a comprehensive review. Clin Rev Allergy Immunol. 2017;53(3):469–76.CrossRefGoogle Scholar
  2. 2.
    Costedoat-Chalumeau N, Amoura Z, Lupoglazoff JM, Huong DL, Denjoy I, Vauthier D, Sebbouh D, Fain O, Georgin-Lavialle S, Ghillani P, Musset L, Wechsler B, Duhaut P, Piette JC. Outcome of pregnancies in patients with anti-SSA/Ro antibodies: a study of 165 pregnancies, with special focus on electrocardiographic variations in the children and comparison with a control group. Arthritis Rheum. 2004;50(10):3187–94.CrossRefGoogle Scholar
  3. 3.
    Silverman E, Jaeggi E. Non-cardiac manifestations of neonatal lupus erythematosus. Scand J Immunol. 2010;72(3):223–5.CrossRefGoogle Scholar
  4. 4.
    Prendiville JS, Cabral DA, Poskitt KJ, Au S, Sargent MA. Central nervous system involvement in neonatal lupus erythematosus. Pediatr Dermatol. 2003;20(1):60–7.CrossRefGoogle Scholar
  5. 5.
    Boros CA, Spence D, Blaser S, Silverman ED. Hydrocephalus and macrocephaly: new manifestations of neonatal lupus erythematosus. Arthritis Rheum. 2007;57(2):261–6.CrossRefGoogle Scholar
  6. 6.
    Kale A, Jaybhaye D, Bonde V. Neonatal sepsis: an update. Iran J Neonatol. 2014;4(4):39–51.Google Scholar
  7. 7.
    Rastogi MV, LaFranchi SH. Congenital hypothyroidism. Orphanet J Rare Dis. 2010;5:17.CrossRefGoogle Scholar
  8. 8.
    Anuwutnavin S, Wanitpongpan P, Chungsomprasong P, Soongswang J, Srisantiroj N, Wataganara T. Fetal long QT syndrome manifested as atrioventricular block and ventricular tachycardia: a case report and a review of the literature. Pediatr Cardiol. 2013;34(8):1955–62.CrossRefGoogle Scholar
  9. 9.
    Beinder E, Grancay T, Menendez T, Singer H, Hofbeck M. Fetal sinus bradycardia and the long QT syndrome. Am J Obstet Gynecol. 2001;185(3):743–7.CrossRefGoogle Scholar
  10. 10.
    Saleeb S, Copel J, Friedman D, Buyon JP. Comparison of treatment with fluorinated glucocorticoids to the natural history of autoantibody-associated congenital heart block: retrospective review of the research registry for neonatal lupus. Arthritis Rheum. 1999;42(11):2335–45.CrossRefGoogle Scholar
  11. 11.
    Izmirly PM, Saxena A, Sahl SK, Shah U, Friedman DM, Kim MY, Buyon JP. Assessment of fluorinated steroids to avert progression and mortality in anti-SSA/Ro-associated cardiac injury limited to the fetal conduction system. Ann Rheum Dis. 2016;75(6):1161–5.CrossRefGoogle Scholar
  12. 12.
    Jaeggi ET, Fouron JC, Silverman ED, Ryan G, Smallhorn J, Hornberger LK. Transplacental fetal treatment improves the outcome of prenatally diagnosed complete atrioventricular block without structural heart disease. Circulation. 2004;110(12):1542–8.CrossRefGoogle Scholar
  13. 13.
    Yoshida H, Iwamoto M, Sakakibara H, Shigeta H, Hirahara F, Sato K. Treatment of fetal congenital complete heart block with maternal administration of beta-sympathomimetics (terbutaline): a case report. Gynecol Obstet Investig. 2001;52(2):142–4.CrossRefGoogle Scholar
  14. 14.
    Saxena A, Izmirly PM, Mendez B, Buyon JP, Friedman DM. Prevention and treatment in utero of autoimmune-associated congenital heart block. Cardiol Rev. 2014;22(6):263–7.CrossRefGoogle Scholar
  15. 15.
    Llanos C, Izmirly PM, Katholi M, Clancy RM, Friedman DM, Kim MY, Buyon JP. Recurrence rates of cardiac manifestations associated with neonatal lupus and maternal/fetal risk factors. Arthritis Rheum. 2009;60(10):3091–7.CrossRefGoogle Scholar
  16. 16.
    Brucato A, Frassi M, Franceschini F, Cimaz R, Faden D, Pisoni MP, Muscara M, Vignati G, Stramba-Badiale M, Catelli L, Lojacono A, Cavazzana I, Ghirardello A, Vescovi F, Gambari PF, Doria A, Meroni PL, Tincani A. Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: a prospective study of 100 women. Arthritis Rheum. 2001;44(8):1832–5.CrossRefGoogle Scholar
  17. 17.
    Eliasson H, Sonesson SE, Sharland G, Granath F, Simpson JM, Carvalho JS, Jicinska H, Tomek V, Dangel J, Zielinsky P, Respondek-Liberska M, Freund MW, Mellander M, Bartrons J, Gardiner HM. Isolated atrioventricular block in the fetus: a retrospective, multinational, multicenter study of 175 patients. Circulation. 2011;124(18):1919–26.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ross Petty
    • 1
  • Farhad Salehzadeh
    • 2
  1. 1.Pediatric RheumatologyUniversity of British ColumbiaVancouverCanada
  2. 2.Pediatric RheumatologyBouali Children’s Hospital, ARUMSArdabilIran

Personalised recommendations